# Analysis of antibiotics consumption pattern among hospitalized patients in Nepal: a nationally representative multi-hospital survey

## TL;DR

This study analyzed antibiotic use in hospitalized patients in Nepal and found overuse of 'Watch' antibiotics and underuse of 'Access' antibiotics, which could contribute to antimicrobial resistance.

## Contribution

The study provides a nationally representative analysis of AWaRe antibiotic consumption patterns in Nepalese hospitals.

## Key findings

- Access group antibiotics were used by 29.8% of inpatients, Watch by 70.1%, and Reserve by 0.1%.
- Ceftriaxone and Piperacillin tazobactam were the most commonly used Watch group antibiotics.
- The low use of Access antibiotics and high use of Watch antibiotics may promote antimicrobial resistance.

## Abstract

Antimicrobial resistance (AMR) is a global public health issue with multisectoral contribution. It increases morbidity, mortality and health related expenditures. Antibiotics are divided into three groups of Access, Watch and Reserve (AWaRe) in order to consider antibiotic stewardship. This study aimed at assessing the consumption pattern of AWaRe groups of antibiotics by inpatients in different hospitals of Nepal.

This was a cross-sectional hospital based study. A proforma was developed to obtain data regarding the use of AWaRe groups of antibiotics. All the patients admitted to medical and surgical wards of the selected referral hospitals of seven provinces were included in the study and data on antibiotics use were collected for a month. Data was entered in Microsoft Excel and analyzed in IBM SPSS version 21 using descriptive statistics.

The consumption of AWaRe group of antibiotics among the inpatients were found to be 29.8%, 70.1% and 0.1% respectively. The most frequently consumed antibiotics were Metronidazole and Ornidazole for Access group, Ceftriaxone and Piperacillin tazobactam for Watch group and Linezolid for Reserve group.

The target of increasing the proportion of global consumption of Access antibiotics to at least 60% of total consumption is stated by WHO. However, the minimal use of antibiotics from “Access” category and over use of antibiotics from “Watch” category can promote antimicrobial resistance. Rationale and appropriate use of antibiotics are important to minimize antimicrobial resistance.