Outpatient Pediatric Antibiotic Prescribing Practices Based on the WHO Access, Watch, and Reserve (AWaRe) Framework
David Raj Edla
Department of Pharmacy Practice, Care College of Pharmacy, Kakatiya University, Hanamkonda, Telangana, India.
Haritha Pasupulati
Department of Pharmacy Practice, Bharat School of Pharmacy, Hyderabad, Telangana, India.
Satyanarayana SV Padi
*
Department of Pharmacy Practice, Care College of Pharmacy, Kakatiya University, Hanamkonda, Telangana, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Children's unique growth and weakened immune systems make them more vulnerable to infections, particularly upper respiratory tract infections. Notably, inappropriate antibiotic prescribing patterns are mainly due to nonprescription use, overuse and misuse of antibiotics, causing high consumption and ultimately leading to antimicrobial resistance (AMR). Indeed, AMR is increasing globally and rapidly spreading in middle and low-income countries. WHO categorized antibiotics into ‘Access’, ‘Watch’, and ‘Reserve’ (AWaRe) groups to evaluate and monitor rational use of antibiotics and help global collaboration to tackle AMR.
Objectives: To assess outpatient pediatric antibiotic prescribing practice based on the WHO Access, Watch, and Reserve (AWaRe) framework.
Methodology: A prospective cross-sectional observational study was conducted to assess antibiotic prescribing practices in the outpatient department of a private tertiary care pediatric hospital, Hanamkonda, Telangana, India, emphasizing infectious diseases and rational antibiotic use based on the WHO prescribing indicators, AWaRe categories, and AWaRe index metrics. A simple random sampling technique was employed to collect prescriptions at the hospital for six months. Descriptive statistics were applied to the collected data.
Results: The study analysed 891 pediatric outpatient encounters, comprising 65.8% males and 34.2% females, with infants (38.1%), followed by early childhood (29.0%), being the most frequent. Out of 678 antibiotic prescriptions, 96.9% consists of one antibiotic and 3.1% consists of two. Upper respiratory tract infections (49.6%) were the most commonly diagnosed in the present study. The present study, 2.8 was the average number of drugs per encounter, 76.1% prescriptions had antibiotics, parenteral drugs were not prescribed, 2.4% prescriptions had generic name drugs, and 45.9% prescribed drugs listed in the EMLc. The most commonly prescribed antibiotic in pediatric outpatient patients was azithromycin (20.9%), followed by cefpodoxime (18.2%). The study observed that 'Watch' category antibiotics (72.4%) were prescribed more than 'Access' (26.9%); however, 'Reserve' antibiotics (0.7%) were the least prescribed. The amoxicillin index was 12.6%, the 'Access' antibiotic index was 26.0%, while the 'Access to Watch' index was 0.37, which are lower than the priority value.
Conclusion: There is still scope for improving prescribing practices of ‘Access’ antibiotics over ‘Watch' antibiotics, considering the patient factors, antibiograms, and availability of antibiotics. The implementation of the WHO AWaRe framework encourages the responsible and rational use of antibiotics and improves prescribing practices to monitor antimicrobial use and effectively tackle AMR.
Keywords: Access antibiotics, antimicrobial resistance, AWaRe classification, pediatrics, rational use, reserve antibiotics, watch antibiotics