Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Dec 20, 2023; 13(5): 123-133
Published online Dec 20, 2023. doi: 10.5493/wjem.v13.i5.123
Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India
Gunjita Negi, Arjun KB, Prasan Kumar Panda
Gunjita Negi, Arjun KB, Prasan Kumar Panda, Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh 249203, India
Author contributions: Negi G, KB A, and Panda PK gave the concept, designed the project, collected the data, analysed, wrote the manuscript, critically reviewed, and approved the manuscript.
Institutional review board statement: The study was reviewed and approved by Institutional Ethics Committee of All India Institute of Medical Sciences, Rishikesh, India.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: Will be shared with correspondence to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prasan Kumar Panda, MBBS, MD, Associate Professor, Department of Medicine, All India Institute of Medical Sciences, Room No. 409, Rishikesh 249203, India. motherprasanna@rediffmail.com
Received: August 12, 2023
Peer-review started: August 12, 2023
First decision: September 14, 2023
Revised: October 10, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 20, 2023
Processing time: 128 Days and 12.9 Hours
Abstract
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.

Keywords: Antimicrobial resistance; AWaRe classification; Access; Watch; Reserve; Daily defined dose; Questionnaire based survey

Core Tip: With the rise in antimicrobial resistance (AMR) particularly in developing countries it is the need of the hour to adopt better prescribing practices. It is important to raise knowledge and awareness about AMR and improve adherence to guidelines. The research highlights areas of improvement in prescribing practices.