Evaluation of Antibiotic Prescribing Patterns Using WHO Prescribing Indicators and the AWaRe in a Tertiary Care Hospital in Northern Kerala

Introduction/Objectives: Antimicrobial resistance from improper antibiotic use poses a global health threat. Understanding prescribing patterns is essential to promote rational use. This study analyzed antibiotic prescribing in a tertiary care hospital using WHO prescribing indicators and the AWaRe classification. Methods: A six‑month retrospective cross‑sectional study of 150 patients assessed sociodemographic and clinical profiles. Antibiotic consumption was measured using the Defined Daily Dose (DDD/1000 inhabitants/day). WHO indicators such as average antibiotics per encounter, generic prescribing, Essential Medicines List use, injection frequency, and AWaRe categories were applied to evaluate appropriateness. results: Piperacillin and tazobactam was the antibiotic most frequently consumed (10.7 DDD/1000/day). Only 35.8% of antibiotics belonged to the Access category, while 56.1% were from the category of Watch, and prescriptions from the Reserve and Not Recommended categories were 3.7% and 4.4%, respectively. The average number of antibiotics per encounter was 1.6, adhering to WHO standards. Only 27.2% were prescribed under a generic name, while 93.5% of antibiotics were from the Essential Medicine List, and 61.8% were as injections. Results: Piperacillin‑tazobactam was most consumed (10.7 DDD/1000/day). Access antibiotics accounted for 35.8%, Watch 56.1%, Reserve 3.7%, and Not Recommended 4.4%. The average number of antibiotics per encounter was 1.6, within WHO standards. Generic prescribing was low (27.2%), while 93.5% were from the EML. Injections were frequent (61.8%). Discussion: Prescribing aligned with WHO standards for average antibiotics per encounter (1.64 vs. 2.01 in prior studies). However, injection use (61.8%) exceeds the optimal range of the WHO. EML adherence was high (93.5%), but generic prescribing was poor compared to 87.5% of another study. Access group use (35.8%) did not meet the WHO’s ≥60% target, while Watch group use (56.1%) was excessive yet comparable to other reports. Reserve and Not Recommended antibiotics were used less than in some studies. Amoxicillin‑clavulanate and piperacillin‑tazobactam were the most prescribed, with higher DDDs than comparative findings. Conclusion: Prescribing patterns did not fully comply with WHO indicators or AWaRe targets. Excessive use of watch groups underscores the need for strengthening antibiotic stewardship programs.