{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T00:04:19Z","timestamp":1793664259939,"version":"4.5.1"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fleming Fund Country Grant to Bangladesh","award":["FF48-416 FFCGB 1"],"award-info":[{"award-number":["FF48-416 FFCGB 1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15\u201364 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.<\/jats:p>","DOI":"10.3390\/antibiotics11060810","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T01:48:12Z","timestamp":1655430492000},"page":"810","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7891-8191","authenticated-orcid":false,"given":"Md. Mahbubur","family":"Rashid","sequence":"first","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"School of Women\u2019s & Children\u2019s Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5054-9243","authenticated-orcid":false,"given":"Zubair","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"},{"name":"Biosecurity Research Program, The Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3053-4241","authenticated-orcid":false,"given":"Sukanta","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Ariful","family":"Islam","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahana","family":"Parveen","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1580-5883","authenticated-orcid":false,"given":"Probir Kumar","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aninda","family":"Rahman","sequence":"additional","affiliation":[{"name":"Communicable Disease Control (CDC), Directorate General of Health Services, Government of Bangladesh, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-7188","authenticated-orcid":false,"given":"Zobaidul Haque","family":"Khan","sequence":"additional","affiliation":[{"name":"Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8303-0947","authenticated-orcid":false,"given":"Khaleda","family":"Islam","sequence":"additional","affiliation":[{"name":"Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitish","family":"Debnath","sequence":"additional","affiliation":[{"name":"Fleming Fund Country Grant to Bangladesh, DAI Global, LLC, House 3, Road 23B, Gulshan 1, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmudur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Global Health Development, EMPHNET, 69 Mohakhali, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S1473-3099(18)30605-4","article-title":"Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis","volume":"19","author":"Cassini","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.drup.2006.06.002","article-title":"Bacterial resistance: A sensitive issue Complexity of the challenge and containment strategy in Europe","volume":"9","author":"Jansen","year":"2006","journal-title":"Drug Resist. Updates"},{"key":"ref_3","unstructured":"Mark, S., Smolinski, M.A.H., and Lederberg, J. (2003). Microbial Threats to Health: Emergence, Detection, and Response, National Academies Press."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Collaborators","year":"2022","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jhin.2019.05.014","article-title":"Variations in antibiotic use across India: Multi-centre study through Global Point Prevalence survey","volume":"103","author":"Singh","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hoque, R., Ahmed, S.M., Naher, N., Islam, M.A., Rousham, E.K., Islam, B.Z., and Hassan, S. (2020). Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227947"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.4269\/ajtmh.17-0988","article-title":"Burden and Risk Factors of Antimicrobial Use in Children Less Than 5 Years of Age with Diarrheal Illness in Rural Bangladesh","volume":"98","author":"Ahmed","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-14-847","article-title":"Self medicated antibiotics in Bangladesh: A cross-sectional health survey conducted in the Rajshahi City","volume":"14","author":"Biswas","year":"2014","journal-title":"BMC Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1093\/clinids\/5.6.1033","article-title":"Antimicrobial Resistance in Hospital Organisms and Its Relation to Antibiotic Use","volume":"5","author":"McGowan","year":"1983","journal-title":"Rev. Infect. Dis."},{"key":"ref_10","unstructured":"WHO (2022, May 22). The Global Action Plan on Antimicrobial Resistance, Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/254352\/sea-cd-308.pdf?sequence=1&isAllowed=y."},{"key":"ref_11","unstructured":"WHO (2022, May 22). WHO Access, Watch, Reserve (AWaRe) Classification of Antibiotics for Evaluation and Monitoring of Use, Available online: https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1374989\/retrieve."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"dlab017","DOI":"10.1093\/jacamr\/dlab017","article-title":"Comparative analysis of Australian hospital antimicrobial utilization, using the WHO AWaRe classification system and the adapted Australian Priority Antimicrobial List (PAL)","volume":"3","author":"Hillock","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4274\/tjps.galenos.2020.11456","article-title":"Evaluation of Prescribing Patterns of Antibiotics Using Selected Indicators for Antimicrobial Use in Hospitals and the Access, Watch, Reserve (AWaRe) Classification by the World Health Organization","volume":"18","author":"Mugada","year":"2021","journal-title":"Turk. J. Pharm. Sci"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/S2214-109X(18)30186-4","article-title":"Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey","volume":"6","author":"Versporten","year":"2018","journal-title":"Lancet Glob. Health"},{"key":"ref_15","unstructured":"(2022, May 22). International Experts Join Forces against Superbugs at the 4th World Forum on Healthcare-Associated Infections and Antimicrobial Resistance. Available online: https:\/\/www.biomerieux.com\/content\/dam\/biomerieux-com\/investor\/regulated-informations\/2013\/releases\/pr_biomerieux_world_hai_forum_20130627_en.pdf.coredownload.pdf."},{"key":"ref_16","unstructured":"Goossens, H., and Nathwani, D. (2022, May 22). Global Point Prevalence Survey of Antimicrobial Consumption and Resistance. Available online: https:\/\/www.global-pps.com\/wp-content\/uploads\/2019\/02\/Global-PPS-2019-protocol.pdf."},{"key":"ref_17","unstructured":"WHO (2022, May 22). WHO Methodology for Point Prevalence Survey on Antibiotic Use in Hospitals, Version 1.1, Available online: https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1175969\/retrieve."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e4099","DOI":"10.1097\/MD.0000000000004099","article-title":"High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey","volume":"95","author":"Le","year":"2016","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.18773\/austprescr.2005.030","article-title":"Antibiotics for surgical prophylaxis","volume":"28","author":"Munckhof","year":"2005","journal-title":"Aust. Prescr."},{"key":"ref_20","unstructured":"(2022, May 22). Management Information System. HEALTH BULLETIN 2019, Available online: https:\/\/old.dghs.gov.bd\/images\/docs\/Publicaations\/Health%20Bulletin%202019%20Print%20Version%20(2)-Final.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1093\/jac\/dkaa533","article-title":"A multicentre point prevalence survey (PPS) of antimicrobial use amongst admitted patients in tertiary care centres in India","volume":"76","author":"Panditrao","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1093\/jac\/dkab050","article-title":"Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): Results from a worldwide point prevalence survey in 69 countries","volume":"76","author":"Pauwels","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13756-018-0299-z","article-title":"Antibiotic use in a tertiary healthcare facility in Ghana: A point prevalence survey","volume":"7","author":"Labi","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1080\/14787210.2021.1941870","article-title":"A multicentre point prevalence study of antibiotics utilization in hospitalized patients in an urban secondary and a tertiary healthcare facilities in Nigeria: Findings and implications","volume":"20","author":"Ogunleye","year":"2022","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1080\/14787210.2019.1629288","article-title":"Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications","volume":"17","author":"Tiroyakgosi","year":"2019","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/14787210.2019.1581063","article-title":"A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: Findings and implications","volume":"17","author":"Saleem","year":"2019","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"fmaa093","DOI":"10.1093\/tropej\/fmaa093","article-title":"Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh","volume":"67","author":"Boone","year":"2021","journal-title":"J. Trop. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"dlaa048","DOI":"10.1093\/jacamr\/dlaa048","article-title":"Community-level consumption of antibiotics according to the AWaRe (Access, Watch, Reserve) classification in rural Vietnam","volume":"2","author":"Nguyen","year":"2020","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_29","unstructured":"UK Health Security Agency (2022, May 22). English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR): Report 2019 to 2020, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/1069632\/espaur-report-2020-to-2021-16-Nov-FINAL-v2.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Akhtar, Z., Mah-E-Muneer, S., Islam, M.A., Chowdhury, S., Rashid, M.M., Ahmed, M.S., Khan, Z., Hassan, M.Z., Parveen, S., and Rahman, N.D.M. (2021). Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh. Antibiotics, 10.","DOI":"10.3390\/antibiotics10091052"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Mah-E-Muneer, S., Hassan, M.Z., Biswas, M.A.A.J., Rahman, F., Akhtar, Z., Das, P., Islam, M.A., and Chowdhury, F. (2021). Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic. Antibiotics, 10.","DOI":"10.3390\/antibiotics10060738"},{"key":"ref_32","unstructured":"(2022, May 22). Desk, Tribune. \u2018No Mask, No Service\u2019. Dhaka Tribune. Available online: https:\/\/archive.dhakatribune.com\/bangladesh\/government-affairs\/2020\/10\/31\/no-mask-no-entry."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.cmi.2021.10.001","article-title":"Indications for medical antibiotic prophylaxis and potential targets for antimicrobial stewardship intervention: A narrative review","volume":"28","author":"Ioannou","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_34","unstructured":"Crader, M.F., and Varacallo, M. (2022). Preoperative Antibiotic Prophylaxis, StatPearls Publishing."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"225","DOI":"10.18773\/austprescr.2017.073","article-title":"Surgical antimicrobial prophylaxis","volume":"40","author":"Ierano","year":"2017","journal-title":"Aust. Prescr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"391","DOI":"10.4314\/tjpr.v19i2.23","article-title":"A prospective antibiotic point prevalence survey in two primary referral hospitals during and after pilgrims stay in Madinah, Saudi Arabia","volume":"19","author":"Yaser","year":"2020","journal-title":"Trop. J. Pharm. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-020-00814-6","article-title":"Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: Results from an antimicrobial stewardship intervention","volume":"9","author":"Segala","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1093\/jac\/dkaa514","article-title":"Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: An observational, cross-sectional study","volume":"76","author":"Larramendy","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum beta-lactamases: A clinical update","volume":"18","author":"Paterson","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1128\/CMR.00002-15","article-title":"Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections","volume":"28","author":"Crump","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1086\/382359","article-title":"Short-Course Azithromycin for the Treatment of Uncomplicated Typhoid Fever in Children and Adolescents","volume":"38","author":"Robert","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1111\/j.1365-3156.2011.02837.x","article-title":"Susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asia to macrolide antibiotics","volume":"16","author":"Lubell","year":"2011","journal-title":"Trop. Med. Int. Health"},{"key":"ref_43","unstructured":"WHO (2022, May 22). In the Face of Slow Progress, WHO Offers a New Tool and Sets a Target to Accelerate Action against Antimicrobial Resistance, Available online: 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":"ref_44","unstructured":"WHO (2022, May 22). The Selection and Use of Essential Medicines, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241210157."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3384","DOI":"10.1093\/jac\/dkz321","article-title":"Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: Being AWaRe","volume":"74","author":"Budd","year":"2019","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/810\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:33:02Z","timestamp":1760139182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/6\/810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,16]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["antibiotics11060810"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11060810","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,16]]}}}