Pattern of hospital antibiotic use in term neonates using WHO Access, Watch and Reserve Classification (AWaRe)

Background and Objective: Pakistan has high neonatal mortality rate and antibiotic utilization data in hospitalized term neonates from Pakistan is lacking. The study aimed to determine the pattern of hospital antibiotic use in term neonates using World Health Organization (WHO) Access, Watch, and Reserve classification (AWaRe).

Methods: This cross-sectional chart review study was conducted at the neonatal unit of Pediatric Medicine Department of University Hospital over a period of one year from 1st January 2020 to 31st December 2020. Hospitalized full term newborns up to 28-days of life, of either gender were consecutively included in the study. Data on demographic characteristics, admission diagnoses and antibiotic prescribed (class, agent and duration) were extracted from clinical charts. Descriptive statistics in the form of mean ± SD and frequency and percentages were calculated.

Results: A total of 2276 term neonates consisting of 69% (n=1570) males were included in the study. Antibiotic prescription rate was 92.8%. Most common reason for admission was birth asphyxia (36.1%) followed by sepsis (33%). Most commonly prescribed antibiotic Ampicillin (84%) belonged to Access group of WHO – AWaRe classification. More than 97% of prescriptions were two or more antimicrobial combinations belonging to Watch group. Ampicillin and Cefoperazone was the most commonly prescribed (42.8%) two drug combination. Meropenem and vancomycin was prescribed to 20% of the neonates – mostly for sepsis and pneumonia. Mortality rate was 7.7% in current study.

Conclusion: High antibiotic prescription rate particularly from Watch-group is demonstrated in this study. There is high need of antimicrobial stewardship program in neonatal units.