{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:09:12Z","timestamp":1789193352185,"version":"build-2803163510"},"reference-count":37,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Objective<\/jats:title>\n To describe antibacterial consumption (ABC) in four paediatric inpatient facilities in Sri Lanka in 2023.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Descriptive cross-sectional study, adapted from the WHO Global Antimicrobial Resistance and Use Surveillance System methodology.<\/jats:p>\n <\/jats:sec>\n \n Settings<\/jats:title>\n Paediatric inpatient facilities in two tertiary and two secondary care government hospitals located across three provinces.<\/jats:p>\n <\/jats:sec>\n \n Data<\/jats:title>\n Data on antibacterials for systemic use, J01 in the Anatomical Therapeutic Chemical (ATC) classification issued to these paediatric inpatient facilities in 2023 by their respective hospital pharmacies.<\/jats:p>\n <\/jats:sec>\n \n Outcome measures<\/jats:title>\n (1) ABC at ATC third and fifth levels expressed as defined daily doses (DDDs)\/100 admissions, (2) ABC as per WHO \u2018Access, Watch and Reserve\u2019 category, (3) choice of antibacterials within a class, (4) DU 75% for oral and parenteral dosage forms, (5) quality indicators such as amoxicillin index and broad:narrow spectrum ratio.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In 2023, total antibacterial (J01) consumption across the four paediatric inpatient facilities was 94.49 DDDs\/100 admissions. Together, non-penicillin beta-lactams, penicillins and macrolides\/lincosamides\/streptogramins accounted for 90\u201398%. Co-amoxiclav was the most consumed antibacterial, and six agents (co-amoxiclav, cefotaxime, clarithromycin, azithromycin, cefuroxime and meropenem) collectively accounted for 70\u201390%. Aminoglycosides, tetracyclines, sulfonamides and trimethoprim, and quinolones contributed minimally. Access and Watch group antibacterials accounted for 34 and 65%. Quality indicators demonstrated disproportionately higher use of broad-spectrum and Watch group antibacterials.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n High use of broad-spectrum and Watch-group antibacterials was observed across the four paediatric inpatient facilities. The findings highlight targets for antibacterial stewardship programmes and demonstrate the feasibility of ABC surveillance in Sri Lanka.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119685","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:15:43Z","timestamp":1789190143000},"page":"e119685","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Antibacterial consumption in four paediatric inpatient facilities in Sri Lanka in 2023: a cross-sectional descriptive study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0184-104X","authenticated-orcid":false,"given":"Shalini","family":"Sri Ranganathan","sequence":"first","affiliation":[{"name":"Pharmacology, University of Colombo, Colombo, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5210-5141","authenticated-orcid":false,"given":"Pamodh Chanuka","family":"Yasawardene","sequence":"additional","affiliation":[{"name":"Pharmacology, University of Colombo, Colombo, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savini","family":"Senadheera","sequence":"additional","affiliation":[{"name":"Pharmacy and Pharmaceutical Sciences, University of Sri Jayewardenepura Faculty of Allied Health Sciences, Nugegoda, Western Province, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahamayagoda Arachchige Maheshaka","family":"Wijayawardena","sequence":"additional","affiliation":[{"name":"Base Hospital Wathupitiwala, Gampaha, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupasinghe Jayasundara Muhandiramge","family":"Jayasundara","sequence":"additional","affiliation":[{"name":"Base Hospital Thambuththegama, Anuradhapura, North Central Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thelesinghe Mudalige Ruwanthi","family":"Perera","sequence":"additional","affiliation":[{"name":"Paediatrics, University of Sri Jayewardenepura Faculty of Medical Sciences, Nugegoda, Western Province, Sri Lanka"},{"name":"Colombo South Teaching Hospital, Kalubowila, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruwangi","family":"Dissanayake","sequence":"additional","affiliation":[{"name":"Paediatrics, University of Colombo Faculty of Medicine, Colombo, Western Province, Sri Lanka"},{"name":"Lady Ridgeway Hospital for Children, Colombo, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosalakumar Wickramarachchi","family":"Karunaratne","sequence":"additional","affiliation":[{"name":"Lady Ridgeway Hospital for Children, Colombo, Western Province, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091122152696000_16.9.e119685.1","unstructured":"World Health Organization . Global antibiotic resistance surveillance report 2025: WHO global antimicrobial resistance and use surveillance system (GLASS). Geneva World Health Organization; 2025."},{"key":"2026091122152696000_16.9.e119685.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0285170","article-title":"The economic burden of antibiotic resistance: A systematic review and meta-analysis","volume":"18","author":"Poudel","year":"2023","journal-title":"PLoS One"},{"key":"2026091122152696000_16.9.e119685.3","doi-asserted-by":"crossref","unstructured":"Organisation for Economic Co-operation and Development . Embracing a one health framework to fight antimicrobial resistance. OECD Health Policy Studies; 2023. doi:10.1787\/ce44c755-en","DOI":"10.1787\/ce44c755-en"},{"key":"2026091122152696000_16.9.e119685.4","unstructured":"World Health Organization . Antimicrobial resistance. WHO; 2023. Available: https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/antimicrobial-resistance"},{"key":"2026091122152696000_16.9.e119685.5","doi-asserted-by":"crossref","first-page":"e291","DOI":"10.1016\/S2542-5196(23)00026-8","article-title":"Global antimicrobial-resistance drivers: an ecological country-level study at the human-animal interface","volume":"7","author":"Allel","year":"2023","journal-title":"Lancet Planet Health"},{"key":"2026091122152696000_16.9.e119685.6","doi-asserted-by":"publisher","DOI":"10.1021\/acs.accounts.8b00643"},{"key":"2026091122152696000_16.9.e119685.7","unstructured":"World Health Organization . Global action plan on antimicrobial resistance. World Health Organization; 2015. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241509763"},{"key":"2026091122152696000_16.9.e119685.8","unstructured":"World Health Organization . Interagency coordination group on antimicrobial resistance (IACG). surveillance and monitoring for antimicrobial use and resistance. World Health Organization; 2018. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/antimicrobial-resistance\/iacg-surveillance-and-monitoring-for-amu-and-amr-110618.pdf"},{"key":"2026091122152696000_16.9.e119685.9","unstructured":"World Health Organization . Monitoring global progress on antimicrobial resistance: tripartite amr country self-assessment survey (TrACSS) 2019\u20132020. WHO, 2021"},{"key":"2026091122152696000_16.9.e119685.10","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30332-7"},{"key":"2026091122152696000_16.9.e119685.11","unstructured":"World Health Organization . Global antimicrobial resistance and use surveillance system (GLASS) report. antibiotic use data for 2022. World Health Organization; 2025."},{"key":"2026091122152696000_16.9.e119685.12","unstructured":"Ministry of Health, Sri Lanka . National strategic plan for combating antimicrobial resistance in sri lanka 2017\u20132022. Colombo: Ministry of Health; 2017. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/antimicrobial-resistance\/amr-spc-npm\/nap-library\/national-strategic-plan-for-combating-antimicrobial-resistance-in-sri-lanka-2017%C3%A2-2022.pdf?sfvrsn=3125370f_1"},{"key":"2026091122152696000_16.9.e119685.13","unstructured":"Ministry of Health, Sri Lanka . Ministry of Health; National Strategic Plan for Combating Antimicrobial Resistance in Sri Lanka 2023\u20132028, 2023. Available: https:\/\/www.who.int\/publications\/m\/item\/sri-lanka-national-strategic-plan-for-combating-antimicrobial-resistance-2023-2028"},{"key":"2026091122152696000_16.9.e119685.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0257424","article-title":"A national survey of antibacterial consumption in Sri Lanka","volume":"16","author":"Sri Ranganathan","year":"2021","journal-title":"PLoS One"},{"key":"2026091122152696000_16.9.e119685.15","unstructured":"World Health Organization . GLASS Methodology for Surveillance of National Antimicrobial Consumption. Geneva: World Health Organization, 2020."},{"key":"2026091122152696000_16.9.e119685.16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4038\/cmj.v61i3.8346","article-title":"Resistance and utilisation pattern of antibacterial agents in outpatient settings in two Teaching Hospitals in Colombo","volume":"61","author":"Senadheera","year":"2016","journal-title":"Ceylon Med J"},{"key":"2026091122152696000_16.9.e119685.17","unstructured":"World Health Organization Regional Office for the Western Pacific . Antimicrobial consumption in the who western pacific region: early implementation of the western pacific regional antimicrobial consumption surveillance system (WPRACSS). Manila World Health Organization Regional Office for the Western Pacific; 2021."},{"key":"2026091122152696000_16.9.e119685.18","unstructured":"World health organization collaborating centre for drug statistics methodology. ATC\/DDD Index; 2024. Available: https:\/\/www.whocc.no\/atc_ddd_index\/"},{"key":"2026091122152696000_16.9.e119685.19","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2006.021121"},{"key":"2026091122152696000_16.9.e119685.20","unstructured":"World Health Organization . World health organization model list of essential medicines, 21st list, 2019. World Health Organization; 2019. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/325771\/WHO-MVPEMP-IAU-2019.06-eng.pdf"},{"key":"2026091122152696000_16.9.e119685.21","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4038\/sljm.v30i2.258","article-title":"Point prevalence survey of antimicrobial prescriptions in selected units of National Hospital Kandy, Sri Lanka","volume":"30","author":"Devakanthan","year":"2021","journal-title":"SL J Med"},{"key":"2026091122152696000_16.9.e119685.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-05804-6","article-title":"Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2026091122152696000_16.9.e119685.23","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1017\/ice.2018.321","article-title":"Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices","volume":"40","author":"Sheng","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026091122152696000_16.9.e119685.24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4038\/cmj.v69iSI3.9983","article-title":"Experience of an antimicrobial stewardship programme in a tertiary care hospital in Sri Lanka","volume":"69","author":"Silva","year":"2024","journal-title":"Ceylon Med J"},{"key":"2026091122152696000_16.9.e119685.25","unstructured":"World Health Organization . In the face of slow progress, who offers a new tool and sets a target to accelerate action against antimicrobial resistance. World Health Organization; 2019. Available: https:\/\/www.who.int\/news\/item\/18-06-2019-in-the-face-of-slow-progress-who-offers-a-new-tool-and-sets-a-target-to-accelerate-action-against-antimicrobial-resistance"},{"key":"2026091122152696000_16.9.e119685.26","unstructured":"World Health Organization . The who aware (access, watch, reserve) antibiotic book. World Health Organization; 2022. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240062382"},{"key":"2026091122152696000_16.9.e119685.27","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.12669\/pjms.41.11.12169","article-title":"Prescribing patterns of antibiotics according to the WHO access, watch, and reserve (AWaRe) classification in the pediatric outpatient department: A prospective study","volume":"41","author":"Ramzan","year":"2025","journal-title":"Pak J Med Sci"},{"key":"2026091122152696000_16.9.e119685.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003139","article-title":"Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis","volume":"17","author":"Sulis","year":"2020","journal-title":"PLoS Med"},{"key":"2026091122152696000_16.9.e119685.29","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkv418"},{"key":"2026091122152696000_16.9.e119685.30","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11010018","article-title":"Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012-2018","volume":"11","author":"Barbieri","year":"2021","journal-title":"Antibiotics (Basel)"},{"key":"2026091122152696000_16.9.e119685.31","doi-asserted-by":"crossref","first-page":"717","DOI":"10.24953\/turkjped.2021.4413","article-title":"Comparison of pediatric antibiotic prescribing practice between low and high prescribers for children in primary care","volume":"64","author":"K\u0131rm\u0131z\u0131","year":"2022","journal-title":"Turk J Pediatr"},{"key":"2026091122152696000_16.9.e119685.32","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/pch\/18.6.311","article-title":"Canadian Paediatric Society, Drug Therapy and Hazardous Substances Committee. Azithromycin use in paediatrics: a practical overview","volume":"18","author":"Ovetchkine","year":"2013","journal-title":"Paediatr Child Health"},{"key":"2026091122152696000_16.9.e119685.33","unstructured":"World Health Organization . WHO releases the 2019 aware classification of antibiotics. World Health Organization; 2019. Available: https:\/\/www.who.int\/news\/item\/01-10-2019-who-releases-the-2019-aware-classification-antibiotics"},{"key":"2026091122152696000_16.9.e119685.34","unstructured":"Best Practice Advocacy Centre New Zealand. Azithromycin: use it wisely. Best Practice Journal 2014. Available: https:\/\/bpac.org.nz\/bpj\/2014\/april\/upfront.aspx"},{"key":"2026091122152696000_16.9.e119685.35","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines11112937","article-title":"Extended-Spectrum \u03b2-Lactamases (ESBL): Challenges and Opportunities","volume":"11","author":"Husna","year":"2023","journal-title":"Biomedicines"},{"key":"2026091122152696000_16.9.e119685.36","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-91332-x","article-title":"Impact of antibiotic usage on extended-spectrum \u03b2-lactamase producing Escherichia coli prevalence","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026091122152696000_16.9.e119685.37","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2018-0193"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:15:50Z","timestamp":1789190150000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,11]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-119685"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119685","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}