Evaluation of antibiotic consumption and compliance to hospital antibiotic policy in the surgery, orthopedics and gynecology wards of a tertiary care hospital

Objectives: To evaluate antibiotic consumption and compliance to hospital antibiotic policy in the surgery, orthopedics and gynecology wards of a tertiary care hospital. Methods: A prospective observational study was conducted over eight months on adult inpatients prescribed with antibiotics. Data were collected using a predesigned antibiotic form and evaluated using Defined Daily Dose per 100 bed-days. Antibiotics prescribed were classified using World Health Organization Access, Watch and Reserve classification (WHO AWaRe) and assessed for compliance to the hospital antibiotic policy which is in accordance with the National Treatment Guidelines for Antimicrobial use in Infectious Diseases (version 1.0.2016). Results: Out of 2653 patients enrolled, 44.3% were males and 55.7% were females. The antibiotic usage rate was 29%. Cephalosporins were the most frequently prescribed class of antibiotics. The top three antibiotics prescribed were cefumxime, metronidazole, and ceftriaxone. Classification of antibiotics using WHO AWaRe policy showed that 36% of antibiotics were prescribed from the Access group and 53% from the Watch group. The use of antibiotic combinations from the not recommended group of AWaRe was also observed. Total compliance observed towards the hospital's antibiotic policy was 77.7%. The most common reason for non-compliance to hospital policy was inappropriate duration of antibiotic therapy. Conclusions: The use of watch group of antibiotics over access group due to concerns of antimicrobial resistance shows the need for local adaptation of WHO AWaRe classification. Despite good adherence to the hospital's antibiotic policy, extended duration of antibiotic therapy requires special attention. Further optimization of antibiotic use can be achieved by timely revision and implementation of hospital antibiotic policy.