Hospital Antibiotic Prescribing Pattern in General Surgery Specialty: Analysis Based on the WHO Access, Watch and Reserve (AWaRe) Classification

Background: Surgical site infections are a prevalent cause of nosocomial infections that require antibiotic prophylaxis. Emergence and spread of antimicrobial resistance is a major global public health issue that must be addressed. Eventually, antibiotic prescribing pattern should be examined in order to ensure that antibiotics are used appropriately and that their effectiveness is preserved.

Objective: To evaluate hospital antibiotic prescribing pattern emphasizing on cephalosporins in general surgery specialty using the WHO Access, Watch, and Reserve (AWaRe) classification.

Methodology: A cross-sectional study was carried out in 658 hospitalized patients who received prophylactic antibiotics in general surgery specialty for six months. The data were analysed using the ‘WHO prescribing indicators’ and examined for the WHO ‘AWaRe’ categories. The acquired data was subjected to descriptive statistics.

Results: Per encounter, the average number of drugs and antibiotics prescribed were 3.8 and 1.3, respectively. 83.4% encounters were with at least one antibiotic and 94.5% encounters had parenteral antibiotics. 31.3% and 77.8% antibiotics were prescribed by generic name and from the Essential Medicines List, respectively. The most frequently prescribed antibiotics were the third generation cephalosporins (36.8%) wherein ceftriaxone (22.0%) and cefoperazone (7.2%) were the two most commonly prescribed. A total of 14 specific antibiotics, ‘Access’ 5 and ‘Watch’ 9 were prescribed. Based on the WHO AWaRe classification, 42.3% ‘Access’ and 57.7% ‘Watch’ group antibiotics prescribed. All the prescribed cephalosporins (100%) were from the ‘Watch’ category. Amikacin (13.5%) and ceftriaxone (22.0%) were the most commonly prescribed ‘Access’ and ‘Watch’ group antibiotics, respectively. Amoxicillin index was 7.5 and ‘Access-to-Watch’ index was 0.7, which were much below the priority values.

Conclusion: The antibiotic prescription pattern seen in this study did not entirely meet the WHO recommendations. Antibiotics from the ‘Watch’ category, notably cephalosporins, were commonly prescribed. To retain antibiotic effectiveness and encourage rational antibiotic use, as well as to overcome antibiotic resistance, changes and surveillance antibiotics prescribing are required.