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August 26, 2025

Descriptive cross-sectional study to evaluate antibiotic prescriptions in outpatients using prescribing indicators and access, watch, reserve framework of the World Health Organisation in a teaching hospital

Key Points

The study highlights a significant gap in the prescription of access category antibiotics, which fell below WHO targets.
Among 500 screened prescriptions, only 24.3% included access antibiotics, while watch antibiotics accounted for 42.3%.
This observational cross-sectional study assessed prescribing patterns based on WHO indicators and AWaRE guidelines at a teaching hospital.
The findings reveal a concerning trend of high antibiotic prescription rates, emphasizing the need for better adherence to essential medicines.

Abstract

Objectives: The World Health Organisation (WHO) has set a goal that 60% of the total national antibiotic consumption should be from access category antibiotics by 2023. Reports exploring antibiotic consumption in India showed a rapid increase in the use of watch antibiotics and below-optimal usage of access antibiotics. This study aims to evaluate the prescription pattern of antibiotics using the access, watch, reserve (AWaRE) framework and WHO prescribing indicators. Materials and Methods: An observational cross-sectional study was conducted in a teaching hospital. The data were collected for demographics, the prescribing department and the category of antimicrobial prescribed. The prescriptions were analysed according to the WHO prescribing indicators, and adherence with AWaRe guidelines was also analysed. Results: 720 prescriptions were screened out, of which 500 contained antimicrobials. Among 500 prescriptions, 214 were of male patients, and the remaining were of female patients. The mean age of the participants was 39.1 ± 17.6 years. 50% of the participants belonged to the age group 19–40 years. 432 prescriptions contained only antibiotics, 60 were of antifungal drugs, and 8 contained both antibiotics and antifungal drugs. 29.5% of the prescriptions contained the WHO ‘not recommended’ antibiotic combinations, 24.3% contained access antibiotics, and 42.3% contained watch antibiotics. The average number of drugs per encounter was 4.0, and the percentage of drugs prescribed from the essential medicines was 29.0%. 77.4% of the prescribed medications were generic, and the antibiotic prescription rate was high. Conclusion: The prescription of access category antibiotics was far less than the WHO’s desirable target to be achieved by 2023. The average number of drugs prescribed was higher than recommended, and non-adherence to the essential medicine list was observed.

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