# Enhancing antibiotic stewardship: Physicians’ acceptance of AWaRe (Access, Watch, Reserve)-based microbiology reporting and its impact on judicious antibiotic selection – a cross-sectional study

## TL;DR

This study shows that using a new microbiology report format based on WHO's AWaRe guidelines helps doctors choose better antibiotics and supports antimicrobial stewardship.

## Contribution

A novel microbiology reporting format integrating WHO AWaRe classifications to improve antibiotic prescribing practices.

## Key findings

- 87.2% of physicians preferred AWaRe-based reports over conventional formats.
- 76.7% of participants chose appropriate access antibiotics using the new format.

## Abstract

Inappropriate and excessive use of antimicrobials contributes to the rise of antimicrobial resistance (AMR). To address this, better tools are needed to improve antibiotic prescribing globally. This study evaluates a novel antimicrobial stewardship (AMS) tool – the AWaRe-based microbiology reporting format – developed by the Departments of Microbiology and Infectious Diseases at the Government Medical College, Trivandrum, Kerala state, India. This format incorporates the WHO AWaRe classification into bacterial culture susceptibility reports. The primary objective was to assess the effectiveness of this reporting format in encouraging physicians to choose access antibiotics. The secondary objective was to identify the most preferred microbiology reporting format for antimicrobial susceptibility reports.

A cross-sectional study was conducted among registered modern-medicine practitioners (physicians) in Kerala via social media platforms using a Google form-based questionnaire over a two-month period. Responses were automatically recorded and analysed using descriptive statistical methods. The study included all physicians who gave informed consent, excluding those who declined to participate. The sample size was determined to be 138 based on a pilot study.

A total of 228 physicians participated in the study, 137 (60.1%) of which were clinicians. Among the participants, 199 (87.2%) preferred the AWaRe-based reporting format over conventional formats for effective implementation of the Antimicrobial Stewardship Programme (AMSP). Using this AMS tool, 76.7% (n=56) of participants were successfully guided to choose appropriate access antibiotics.

The study demonstrates that AWaRe-based susceptibility reporting formats can effectively nudge clinicians towards better antibiotic selection, supporting the successful implementation of AMSP (antibiotic stewardship programs). This format also serves as a continuous IEC (Information, Education and Communication) tool, helping clinicians familiarize themselves with WHO AWaRe classifications and encouraging the preferential selection of access-group antibiotics when appropriate.