Addressing Antimicrobial Resistance: A Point Prevalence Survey Using AWaRe Indicators from Outpatient Settings of Multan, Pakistan

Background/Objective: Antimicrobial resistance (AMR) is an escalating public health concern in low- and middle-income countries (LMICs), including Pakistan, where primary care (PC) settings play a significant role in driving inappropriate antibiotic use. This study aimed to evaluate antibiotic prescribing patterns in outpatient departments (OPDs) of hospitals in Multan, Pakistan. Methodology: Data were collected from the OPDs of two hospitals in Multan during two 4-month periods: September to December 2023 and January to April 2024, using the Global Point Prevalence Survey (GPPS) methodology. The GPPS protocol was followed for data collection, and the WHO AWaRe indicators were applied to determine the appropriateness of antibiotic prescriptions in PC settings. Results: Of 1208 patients attending OPDs, 409 (33.85%) received at least one antibiotic. A total of 532 antibiotics were prescribed, of which 65.2% belonged to the Access group, with amoxicillin–clavulanic acid being the most frequently prescribed agent. However, only 41 prescriptions (7.7%) were compliant with WHO AWaRe recommendations, indicating a high level of inappropriate prescribing. Antibiotic use was particularly high for respiratory symptoms such as sore throat, cough, and nasal congestion, which are predominantly viral in origin. While Ophthalmology and Dermatology OPDs had the lowest prescribing rates, Pulmonology and Paediatrics OPDs showed the highest. Conclusion: The study concluded that antibiotic prescribing was frequent in PC OPDs in Multan, with inadequate compliance with WHO AWaRe recommendations, regardless of the excessive use of Access antibiotics. Targeted ASP efforts are necessary to minimize inappropriate antibiotic prescribing. Plain Language Summary: Antibiotic resistance occurs when bacteria no longer respond to medicines used to treat infections. This has become a serious global health problem, particularly in countries such as Pakistan, where many patients seek treatment in hospital outpatient departments (OPDs). Understanding how antibiotics are prescribed in these settings is important for improving their appropriate use. This study examined antibiotic prescribing patterns in the OPDs of two hospitals in Multan, Pakistan, between 2023 and 2024. Data were collected on how frequently antibiotics were prescribed, the clinical reasons for prescribing them, and whether the prescriptions followed the World Health Organization (WHO) AWaRe (Access, Watch, Reserve) classification. The findings showed that about one-third of patients visiting the OPDs received an antibiotic. Most prescribed antibiotics belonged to the WHO “Access” group, which includes medicines recommended for common infections; however, only a small proportion of prescriptions fully complied with WHO guidance. Antibiotics were most frequently prescribed in pediatric and pulmonology clinics, particularly for symptoms such as cough, sore throat, and nasal congestion. These findings highlight frequent antibiotic use in outpatient settings and indicate opportunities to improve prescribing practices. Strengthening antimicrobial stewardship programs, providing evidence-based guidance, and supporting prescribers through education may help promote more appropriate antibiotic use and reduce the risk of antimicrobial resistance. Keywords: antimicrobial prescribing patterns, primary care, outpatients, WHO AWaRe classification, antimicrobial stewardship, multi-drug resistance, global point prevalence survey, public health, infectious diseases