Antibiotic consumption and prescription patterns in a tertiary care hospital in Karachi, Pakistan: a cross-sectional study

Background: Pakistan ranks third among low-middle-income countries (LMICs) in human antibiotic consumption. Moreover, it has alarmingly high antimicrobial resistance rates. Surveillance of antibiotic consumption rates can guide towards more responsible use. Our study aims to describe the antibiotic consumption and prescribing patterns in a tertiary care center in Karachi, Pakistan between 2016 and 2023. Methods: This retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi between 2016 and 2023. Data on antibiotic use was extracted from the hospital’s electronic medical records and pharmacy database. Antibiotic consumption was reported using the defined daily dose (DDD) per 1000 patient-days. Data was also extracted on types of antibiotics consumed and prescription patterns were assessed using WHO AWaRe classification.Watch antibiotics included fluoroquinolones, third-generation cephalosporins, piperacillin-tazobactam, carbapenems, and vancomycin, which require cautious use and early review. Reserve antibiotics included colistin, ceftazidime-avibactam, and tigecycline, which are considered to be last resort agents for confirmed or suspected multidrug-resistant infections. The Chi-Square trend analysis was used to compare the trend in consumption of the WHO AWaRe antibiotic groups. P-value of < 0.05 was considered significant. Results: During the study period, there were 413,596 total admissions, with 67.3% receiving antibiotics during hospitalization. Over eight years, the average antibiotic consumption was 1128.7 DDD/1,000 patient-days, with the greatest in 2016 (1145 DDD/1000 patient-days) and the lowest in 2021 (1009 DDD/1000 patient-days). The top 5 antibiotics utilized were ceftriaxone, meropenem, piperacillin-tazobactam, vancomycin, and cefazolin. According to the WHO AWaRe Classification, Watch antibiotics were the most prescribed (68.8–73.9%), followed by Access antibiotics (58-63.9%), while Reserve antibiotics increased from 3.8% to 5.3% during the study period (p < 0.001). Conclusion: In conclusion, this study reveals that a high proportion of patients receive antibiotics during hospitalization, and the majority of these were from the Watch category. These findings highlight the need to complement AWaRe- and DDD-based surveillance with evaluations of prescribing appropriateness and expanded monitoring to better inform antimicrobial stewardship efforts. Clinical trial number: Not applicable.