What question did this study set out to answer?

The study aimed to evaluate antibiotic prescribing patterns across multiple departments to identify areas for improvement in antimicrobial stewardship and combat resistance.

June 17, 2026Open Access

Evaluation of Prescribing Patterns of Antibiotics in a Tertiary Care Institute “An Access, Watch, Reserve-based Analysis”

Key Points

The study aimed to evaluate antibiotic prescribing patterns across multiple departments to identify areas for improvement in antimicrobial stewardship and combat resistance.
Observational, cross-sectional study design on inpatients receiving systemic antibiotics.
Utilization analysis used ATC classification and WHO DDD methodology alongside the AWaRe framework.
A total of 724 antibiotic prescriptions spanning medicine, surgery, orthopedics, and ICU were included.
Cephalosporins were the most prescribed class, accounting for 40.88% of prescriptions; ceftriaxone was most frequent at 39.92% (5.14 DDD/1000 patient-days).
Empirical therapy was predominant, with 56.49% of cases, while only one culture sample was submitted for analysis.
The watch group accounted for 64.46% of antibiotic use, indicating an over-reliance on less appropriate agents.

Abstract

Abstract Objective: The study aimed to analyze antibiotic utilization patterns in the medicine, surgery, orthopedics, and intensive care unit departments of a tertiary care hospital by assessing the proportionate use of access, watch, and reserve antibiotics (measured in defined daily doses DDDs). The findings aimed to highlight current prescribing practices, identify targets for antimicrobial stewardship (AMS) interventions, and support efforts to combat antimicrobial resistance. Materials and Methods: An observational, cross-sectional study was conducted on antibiotics prescribed to inpatients in the hospital. Utilization pattern was analyzed using the anatomical therapeutic chemical (ATC) classification, World Health Organization DDD methodology, and access, watch, reserve (AWaRe) framework. All inpatients of four departments receiving systemic antibiotics (ATC J01) were included in the study. For antibiotic combinations, each constituent drug was counted separately for DDD calculation. Results: A total of 724 antibiotics prescription were analyzed. Cephalosporins were the most frequently prescribed class (296, 40.88%), followed by penicillins (126, 17.40%). Ceftriaxone was the most prescribed antibiotic (289, 39.92%; 5.14 DDD/1000 patient-days). Combination therapy was observed in 224 cases (30.94%). Empirical therapy predominated (409, 56.49%), with only one culture sample submitted. By AWaRe classification, watch group accounted for 468 (64.46%), access for 254 (35.08%), and reserve for 1 (0.14%) parenteral use (98.62%), and generic prescribing (98%) were almost universal. High DDD were noted for azithromycin (9.14) and amikacin (5.43). Conclusion: The study highlights continued irrational antibiotic use, with over-reliance on watch group agents and minimal microbiological guidance. Strengthening AMS programs is imperative to promote access antibiotic use, encourage culture-based prescribing, rationalize empirical therapy, and reduce unnecessary parenteral administration.

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