Adoption of the World Health Organization access, watch reserve index to evaluate and monitor the use of antibiotics at a tertiary care hospital in India

Sharma, Rameshwar K.; Bansal, Alka; Prakash, Ravi

doi:10.4103/picr.picr_202_19

Cited by 8 publications

(13 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall prescribing of antibiotics in our study is lower than the WHO recommendations, which state that more than 60% of all prescribed antibiotics must be from the Access group by 2023. Figures in our study are consistent with another Indian study which had Access (53.31%), Watch (40.09%) from, and Reserve (3.40%) category[ 16 ], and study done in Zambia with ( n = 384) which had Access (55.5%), Watch (43.1%) and Reserve (1.4%)[ 7 ]. Our findings differ from another study in India[ 17 ] in which Watch group antibiotics accounted for 53.19 % of the total antibiotics and a Bangladesh study in which 64.0% of the patients were treated with antibiotics from the Watch group, 35.6% were treated with antibiotics from the Access group, and only 0.1% were treated with antibiotics from the Reserve group.…”

Section: Discussionsupporting

confidence: 92%

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India

Negi,

KB,

Panda

2023

World J Exp Med

View full text Add to dashboard Cite

BACKGROUND The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance (AMR), which is a global public health concern. India has particularly high rates of AMR, posing a threat to effective treatment. The World Health Organization (WHO) Access, Watch, Reserve (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. AIM To study the prescribing patterns of antimicrobials using WHO AWaRe classification through a cross-sectional study in All India Institute of Medical Sciences Rishikesh. METHODS A 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. RESULTS The study involved a total of 123 patients, each of whom received at least one antimicrobial prescription. Most prescriptions were for inpatients, evenly distributed between Medicine (Internal medicine, Pediatrics, Dermatology) and Surgical departments (General surgery and specialties, Otorhinolaryngology, Ophthalmology, Obstetrics and Gynecology). 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. Most Access antibiotics were prescribed within the Medicine department, and the same department also exhibited a higher frequency of Watch antibiotics prescriptions. The questionnaire survey showed that only a third of participants were aware of the AWaRe classification, and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage. CONCLUSION This study highlights the need for better antimicrobial prescribing practices and increased awareness of the WHO AWaRe classification and 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 Defined Daily Dose 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 AMR.

show abstract

Section: Discussionsupporting

confidence: 92%

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India

Negi,

KB,

Panda

2023

World J Exp Med

View full text Add to dashboard Cite

show abstract

“…Studies from different regions of India shows that penicillins and cephalosporins are being interchangeably used as the most commonly prescribed antibiotics. [ 19 20 21 22 23 27 ] The consistency of our results with previous studies suggests that patterns of use of different classes of antibiotics have changed little over time.…”

Section: Discussionsupporting

confidence: 86%

“…The study showed that, in 2017, 53.31% of antibiotics prescribed belonged to Access, 40.09% to watch and 3.40% to reserve category respectively as compared to 41.21%, 46.94% and 8.15% respectively in 2018. [ 21 ] Though the WHO AWaRe classification specified that at least 60% of antibiotics should be prescribed from the Access group, Hsia et al . in their Point Prevalance Survey (PPS survey, included patients from 56 countries) observed high diversity in patterns of AWaRe antibiotic use among countries.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] Need for increased antibiotic stewardship efforts in children have been addressed in studies, newer tools have been developed to tackle the emerging AMR and patterns of use of antibiotics in children in outpatient settings of different regions and different health care settings have also been revealed in studies. [ 19 20 21 22 23 ] However, there is limited data and no recent data available to assess use of AWaRe antibiotics in children particularly in Eastern part of India.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of use of World Health Organization access, watch, reserve antibiotics and core prescribing indicators in pediatric outpatients in a tertiary care teaching hospital in Eastern India

Mandal¹,

Asad²,

Kayal³

et al. 2022

Perspectives in Clinical Research

View full text Add to dashboard Cite

Objectives: The objective of this study was to analyze antibiotic prescribing patterns in pediatric outpatients in a tertiary care teaching hospital in Eastern India, to identify use of World Health Organization (WHO) access, watch and reserve (AWaRe) antibiotics and to identify rationality of prescribing on the basis of WHO core prescribing indicators. Materials and Methods: Scanned copies of prescriptions were collected from the pediatrics outpatients and antibiotic utilization pattern was analyzed in reference to WHO AWaRe groupings and core prescribing indicators. Results: Over the 3 months study period, 310 prescriptions were screened. The prevalence of antibiotic use 36.77%. The majority of the 114 children who received antibiotics were males (52.64%, 60) and belonged to 1–5 year age group (49.12%, 56). The highest number of antibiotic prescriptions was from the penicillin class (58, 46.60%) followed by cephalosporin (23.29%) and macrolide (16.54%). Most number of prescribed antibiotics belonged to Access group (63, 47.37%), followed by Watch group (51, 38.35%). Average number of drugs per prescription was 2.66, percentage of encounters with injections were 0.64%. Most of the prescriptions were prescribed using generic name (74.18%, 612), 58.30% (481) of drugs were from WHO Model List of Essential Medicines for children. Conclusion: If antibiotics are indicated, more number of antibiotics from the Access group may be used for ambulatory children who attend outpatient department of tertiary care hospitals. A simple combination of metrics based on AWaRe groups and core prescribing indicators may eliminate the problem of unnecessary antibiotic prescribing in children and may broaden the antibiotic stewardship opportunities.

show abstract

“…This upward trend in azithromycin usage aligns with findings from a variety of international research efforts. In India, studies by Mugada et al (2021) and Sharma et al (2021) reported similar patterns, reflecting a broader shift in antibiotic prescription practices. In Malaysia, Mohamad et al (2022) also observed an increase.…”

Section: Discussionmentioning

confidence: 76%

WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance – a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic

Abdelsalam Elshenawy,

Umaru,

Aslanpour

2023

Front. Microbiol.

View full text Add to dashboard Cite

Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO’s AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of “Watch” category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.

show abstract

Adoption of the World Health Organization access, watch reserve index to evaluate and monitor the use of antibiotics at a tertiary care hospital in India

Cited by 8 publications

References 12 publications

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India

Assessment of use of World Health Organization access, watch, reserve antibiotics and core prescribing indicators in pediatric outpatients in a tertiary care teaching hospital in Eastern India

WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance – a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic

Contact Info

Product

Resources

About