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Addressing Antimicrobial Resistance: A Point Prevalence Survey Using AWaRe Indicators from Outpatient Settings of
Muniba Alam1, Muhammad Fawad Rasool1, Abdul Haseeb2
1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan.
Background/Objective:
Antimicrobial resistance (AMR) is an escalating public health concern in low- and middle-income countries (LMICs), including Pakistan, where primary care (PC) settings play a significant role in driving inappropriate antibiotic use. This study aimed to evaluate antibiotic prescribing patterns in outpatient departments (OPDs) of hospitals in Multan, Pakistan.
Methodology:
Data were collected from the OPDs of two hospitals in Multan during two 4-month periods: September to December 2023 and January to April 2024, using the Global Point Prevalence Survey (GPPS) methodology. The GPPS protocol was followed for data collection, and the WHO AWaRe indicators were applied to determine the appropriateness of antibiotic prescriptions in PC settings.
Results:
Of 1208 patients attending OPDs, 409 (33.85%) received at least one antibiotic. A total of 532 antibiotics were prescribed, of which 65.2% belonged to the Access group, with amoxicillin-clavulanic acid being the most frequently prescribed agent. However, only 41 prescriptions (7.7%) were compliant with WHO AWaRe recommendations, indicating a high level of inappropriate prescribing. Antibiotic use was particularly high for respiratory symptoms such as sore throat, cough, and nasal congestion, which are predominantly viral in origin. While Ophthalmology and Dermatology OPDs had the lowest prescribing rates, Pulmonology and Paediatrics OPDs showed the highest.
Conclusion:
The study concluded that antibiotic prescribing was frequent in PC OPDs in Multan, with inadequate compliance with WHO AWaRe recommendations, regardless of the excessive use of Access antibiotics. Targeted ASP efforts are necessary to minimize inappropriate antibiotic prescribing.
Insights
Antibiotic prescribing is high in Pakistan
Area of Science:
- Global Health
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a major public health threat in low- and middle-income countries (LMICs).
- Primary care settings significantly contribute to inappropriate antibiotic use.
- Pakistan faces escalating challenges with AMR, necessitating an evaluation of prescribing practices.
Purpose of the Study:
- To assess antibiotic prescribing patterns in hospital outpatient departments (OPDs) in Multan, Pakistan.
- To evaluate the appropriateness of antibiotic prescriptions using WHO AWaRe indicators.
- To identify areas for improvement in antibiotic stewardship programs (ASPs).
Main Methods:
- Data collected from two hospitals' OPDs in Multan over two 4-month periods (Sept-Dec 2023, Jan-Apr 2024).
- Employed the Global Point Prevalence Survey (GPPS) methodology for data collection.
- Applied WHO AWaRe indicators to assess prescription appropriateness in primary care settings.
Main Results:
- 33.85% of 1208 patients received antibiotics; 532 antibiotics were prescribed.
- Amoxicillin-clavulanic acid was the most frequent prescription; 65.2% were 'Access' group antibiotics.
- Only 7.7% of prescriptions complied with WHO AWaRe recommendations, with high use for viral respiratory infections.
Conclusions:
- Frequent antibiotic prescribing observed in Multan's primary care OPDs.
- Inadequate compliance with WHO AWaRe recommendations, despite high use of 'Access' antibiotics.
- Targeted antibiotic stewardship efforts are crucial to reduce inappropriate prescribing.
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