Use of the WHO AWaRe Framework to assess systemic antibiotic prescribing in a tertiary care hospital of a small island developing state: a cross-sectional study

Abstract Background: Antibiotic misuse drives antimicrobial resistance (AMR), and antimicrobial stewardship (AMS) interventions are central to optimizing use. For AMS strategies to be successful, current prescribing must be examined. This study uses the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification of antibiotics to investigate systemic antibiotic prescribing in a tertiary care hospital in Antigua and Barbuda. Methods: A cross-sectional review of systemic antibiotic prescriptions for the medical, surgical, and maternity inpatient units was performed from 2014 to 2021. Data were analyzed using percentages and averages and presented according to the WHO Anatomical Therapeutic Classification (ATC) and the AWaRe classification of antibiotics. Results: We analyzed 27,676 oral and intravenous systemic antibiotic prescriptions, issued to 12,165 patients between 1 January 2014 to 30 September 2021. Other beta-lactam antibacterials (J01D) were the most prescribed ATC subgroup, followed by other antibacterials (J01X). 56% (n = 15,410) of prescriptions were in the Watch category, while 44% (n = 12,266) were in the Access category using the AWaRe classification. The surgical unit had the highest percentage of Access antibiotic prescriptions at 57% (n = 8,115). The maternity unit followed with 48% (n = 1,353) for Access antibiotics. In contrast, the medical unit had only 27% (n = 2,798) for Access antibiotics, while 73% (n = 7,758) were for Watch antibiotics. Conclusion: A higher proportion of Watch antibiotics emphasizes the need for strengthened AMS interventions. Findings from this single-center study provide essential baseline data and support the use of the WHO AWaRe classification to identify stewardship priorities in small island states. Future research should focus on specific patient cohorts.