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. 2022 Jun 16;11(6):810.
doi: 10.3390/antibiotics11060810.

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

Md Mahbubur Rashid  1   2 , Zubair Akhtar  1   3 , Sukanta Chowdhury  1 , Md Ariful Islam  1 , Shahana Parveen  1 , Probir Kumar Ghosh  1 , Aninda Rahman  4 , Zobaidul Haque Khan  5 , Khaleda Islam  5 , Nitish Debnath  5 , Mahmudur Rahman  6 , Fahmida Chowdhury  1
Affiliations

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

Md Mahbubur Rashid et al. Antibiotics (Basel). .

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.

Keywords: AWaRe; Bangladesh; WHO; access; antibiotics; hospitals; watch.

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Conflict of interest statement

The authors declare no conflict of interest to declare. The funders had no conflict of interest with the study and contents of the manuscript.

Figures

Figure 1
Figure 1
Number of antibacterial agents used for treating patients during hospitalization on the day of the point prevalence survey at different departments of tertiary and secondary level hospitals in Bangladesh from February to April 2021.
Figure 2
Figure 2
Antibiotics usage according to the WHO AWaRe classification at different departments of tertiary and secondary level hospitals in Bangladesh from February to April 2021.
Figure 3
Figure 3
(A,B): Multivariate logistic regression model for the association between Access and Watch-group antibiotics and baseline covariates at tertiary and secondary level hospitals in Bangladesh from February to April 2021.
See this image and copyright information in PMC

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