A cross-sectional study of antibiotic prescription patterns in India using the WHO AWaRe classification

Primary health centres represent the initial point of contact with the health system for most patients, and they account for a large proportion of antibiotic prescriptions in India.

To evaluate the pattern of antibiotic prescriptions at a primary care centre in India based on the WHO AWaRe framework.

From September to November 2024, we collected and analysed data from 525 participants who presented to the outpatient pharmacy of an urban primary health centre in Thiruvananthapuram, Kerala, India, and received a doctor's prescription. Data collected included prescription details, demographic characteristics, disease duration, and relevant clinical history. We assessed the compliance of the prescriptions to the WHO AWaRe guidelines.

One hundred and forty-six (27.8%) of the 525 prescriptions analysed contained antibiotics. Access group antibiotics accounted for 51.4% and watch group accounted for 48.6%. No reserve antibiotic was prescribed. The most frequently prescribed antibiotics were amoxicillin-clavulanic acid (34.2%), followed by azithromycin (22.6%) and ciprofloxacin (17.1%). Non-adherence to the WHO AWaRe guidelines was observed in 56.2% of cases.

Our findings show lower usage of access group antibiotics than the recommended target of 70% by WHO. Stronger antimicrobial stewardship initiatives and prescriber training are needed to improve rational antibiotic use in this setting.