Point Prevalence Survey of Antimicrobial Use in a Tertiary Care Hospital in India Using the WHO Access, Watch, and Reserve (AWaRe) Classification and Its Antimicrobial Stewardship Implications

Background: Antimicrobial resistance is largely driven by inappropriate antimicrobial use. The World Health Organization Access, Watch, and Reserve (AWaRe) classification recommends that most of the total antimicrobial consumption should be from the ‘Access’ group, as these agents are associated with a lower risk of resistance. This study aimed to evaluate antimicrobial utilization patterns and AWaRe distribution in a tertiary care hospital in India, and to identify targets for strengthening antimicrobial stewardship. Methods: A cross-sectional point prevalence survey was conducted in March 2025 among inpatients at a government medical college hospital in Tamil Nadu, India. Data on antimicrobial prescriptions, including indication, number of agents, route of administration, stop date, and culture results, were collected using standardized WHO point prevalence survey forms. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: A total of 351 patients were surveyed, of whom 192 (54.7%) were receiving antimicrobials. Among 245 antimicrobial prescriptions, 132 (53.9%) were empirical, while 113 (46.1%) were guided by susceptibility testing. Overall, 167 (68.2%) were administered intravenously, and 101 (41.2%) of prescriptions had no documented stop date. Third-generation cephalosporins were the most commonly prescribed agents. 'Watch' group antimicrobials accounted for 159 (64.9%) prescriptions, and 'Access' group accounted for 86 (35.1%) prescriptions, which was substantially below the WHO-recommended target. Notably, no 'Reserve' group antimicrobials were prescribed. Conclusion: High use of the ‘Watch’ group antimicrobials, inadequate documentation of stop dates, predominant empirical prescribing, and extensive parenteral administration indicate possible gaps in antimicrobial stewardship practices. Strengthening stewardship intervention by increasing ‘Access’ group use, improving prescription documentation, and promoting targeted therapy with timely de-escalation are essential to optimize antimicrobial use in this setting.