Ground level utility of AWaRe Classification: Insights from a Tertiary Care Center In North India

BackgroundThe overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance (AMR), which is a global public health concern. India has particularly high rates of antimicrobial resistance, posing a threat to effective treatment. The WHO AWaRe classification system was introduced to address this issue and guide appropriate antibiotic prescribing. However, there is a lack of studies examining the prescribing patterns of antimicrobials using the AWaRe classification, especially in North India. Therefore, this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India. AimTo study the prescribing patterns of antimicrobials using WHO AWaRe classification through a cross-sectional study in AIIMS Rishikesh. MethodsA descriptive, cross-sectional study was conducted from July 2022 to August 2022 at a tertiary care hospital. Prescriptions containing at least one antimicrobial were included in the study. Data on prescriptions, including patient demographics, departments, types of antimicrobials prescribed, and duration of treatment, were collected. A questionnaire-based survey was also conducted to assess the knowledge and practices of prescribing doctors regarding the utility of AWaRe classification. ResultsA total of 123 patients were included in the study, with antibiotic prescriptions being written for all of them. Most prescriptions were for inpatients, evenly distributed between Medicine and Surgical departments. Metronidazole and Ceftriaxone were the most prescribed antibiotics. According to the AWaRe classification, 57.61% of antibiotics fell under the Access category, 38.27% in Watch, and 4.11% in Reserve. The majority of Access antibiotics were prescribed in the Medicine department, while Watch antibiotics were more common in the Medicine department as well. The questionnaire survey showed that only a third of participants were aware of the AWaRe classification, and there was a lack of knowledge regarding antimicrobial resistance and the potential impact of AWaRe usage. ConclusionThis study highlights the need for better antimicrobial prescribing practices and increased awareness of the WHO AWaRe classification and antimicrobial resistance (AMR) among healthcare professionals. The findings indicate a high proportion of prescriptions falling under the Access category, suggesting appropriate antibiotic selection. However, there is a significant difference between the WHO DDD and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics. There is room for improvement and educational interventions and antimicrobial stewardship programs should be implemented to enhance knowledge and adherence to guidelines, ultimately contributing to the containment of antimicrobial resistance.