Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh

Abstract

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.

Point prevalence survey to assess antibiotic prescribing pattern among hospitalized patients in a county referral hospital in Kenya

“…However, the use of the Watch class antibiotics was relatively lower than reported in a study conducted in Bangladesh where 64% of the prescribed antibiotics were in the Watch class. Similar to a previous study (Rashid et al, 2022), medical wards had the highest use of antibiotics in the Watch class.…”

Antibiotic point prevalence survey at a tertiary healthcare hospital in India: Identifying strategies to improve the antibiotic stewardship program immediately after a COVID-19 wave

“…However, PPSs conducted in neighbouring countries found prescribing rates of 100% in Bangladesh and 97.3% and 89.67% in Pakistan, far higher than at other times [ [23] , [24] , [25] ]. Our PPS, conducted immediately after a COVID-19 wave, found an antibiotic prescription rate of 41.73 %, which was much lower than the antibiotic prescription rates reported in regional PPSs conducted during a COVID-19 wave and was comparable to the antibiotic prescription rates reported in regional PPSs conducted prior to a COVID-19 wave [ 9 , 10 , [19] , [20] , [21] , [22] , [22] , [22] , [23] , [24] , [25] ]. In contrast to the developing nations of the Indian subcontinent, most developed nations of Europe and America had substantial lower antimicrobial prescription rates (25-34%) in the pre-COVID-19 period [ [26] , [27] , [28] ].…”

“…Another pre-COVID-19 wave PPS in a major tertiary care Indian hospital reported an antibiotic prescription rate of 50.9 % [ 19 ]. Even higher rates of antibiotic prescription were reported in pre-COVID-19 studies from neighbouring countries: 78% in Bangladesh, 77.16% in Pakistan, and 63.4% in Myanmar [ [20] , [21] , [22] ]. Data on antibiotic prescribing in India during major COVID-19 waves are sparse [ 18 ].…”

“…In the OBG ward of our institute, which had the highest rate of antibiotic prescription in any ward, most antibiotics were administered as surgical prophylaxis. Likewise, in pre-COVID-19 times, 81.4% of admitted patients in the OBG ward were prescribed antibiotics [ 20 ]. Also, many patients (78.4%) in our PPS were continued with surgical prophylaxis for more than a day, as reported in previous PPSs [ 9 , 10 ].…”

Association between Antibiotic Use and Hospital-Onset Clostridioides difficile Infection in University Tertiary Hospital in Serbia, 2011–2021: An Ecological Analysis

“…Our results showed that during the study, the most commonly used antibiotics were third-generation cephalosporins, especially ceftriaxone. Results from the study of AU in tertiary hospitals in Bangladesh showed that cephalosporins constituted around 50% of all antibiotics used, especially third-generation cephalosporins, with extensive use of ceftriaxone [ 21 ]. Use of this class of antibiotics is lower than 50% in our hospital.…”