{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:58:48Z","timestamp":1785513528612,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["K2007-70X-20514-01-3"],"award-info":[{"award-number":["K2007-70X-20514-01-3"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2021-00889"],"award-info":[{"award-number":["2021-00889"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Erasmus Mundus Lot-15"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Objectives: To describe and compare decadal antibiotic prescribing patterns and trends by diagnosis groups among ophthalmology inpatients at two private-sector hospitals in Central India. Methods: This observational surveillance study was conducted prospectively for a decade in the ophthalmology inpatient departments of a teaching hospital (TH) and a non-teaching hospital (NTH). Patient-level data on demographics, diagnoses, and antibiotic prescriptions were collected by nurses using a standardised form. Antibiotic utilisation was analysed using WHO\u2019s Anatomical Therapeutic Chemical (ATC) codes and Defined Daily Doses (DDDs), as well as AWaRe groups (Access, Watch, Reserve). Diagnoses were classified into infectious and non-infectious categories, and surgical and non-surgical groups. Prescribing trends were analysed using descriptive statistics and linear regression models. Results: Of 7561 patients (TH: 7305; NTH: 256), antibiotics were prescribed to almost all inpatients (TH: 99%; NTH: 90%). Fluoroquinolones were the most prescribed (TH: 94%; NTH: 71%), predominantly by the oral route (73%). Access-group antibiotics were considerably under-prescribed relative to WHO targets (TH: 3%; NTH: 4%). Watch-group antibiotics comprised 97% (TH) and 96% (NTH) of all prescribed antibiotics, and their prescribing increased significantly over 10 years (p &lt; 0.05). Conclusions: Watch-group fluoroquinolones dominated antibiotic prescribing at both hospitals and increased over the study period. Access-group antibiotics were substantially underutilised. These findings highlight an urgent need for context-specific antibiotic prescribing guidelines and stewardship programmes in ophthalmology settings in LMICs.<\/jats:p>","DOI":"10.3390\/antibiotics15080746","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:02:01Z","timestamp":1785510121000},"page":"746","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic Prescribing Among Inpatients with Ophthalmic Diagnoses: A Decade of Evidence from Two Private-Sector Indian Hospitals"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9165-9393","authenticated-orcid":false,"given":"Megha","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Medicines Focusing on Antibiotics, Karolinska Institutet, Tomtebodav\u00e4gen 18 A, 171 77 Stockholm, Sweden"},{"name":"Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain 456006, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9876-4302","authenticated-orcid":false,"given":"Katherine","family":"Rennie","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Medicines Focusing on Antibiotics, Karolinska Institutet, Tomtebodav\u00e4gen 18 A, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-0907","authenticated-orcid":false,"given":"Hager","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Medicines Focusing on Antibiotics, Karolinska Institutet, Tomtebodav\u00e4gen 18 A, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubhra","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain 456006, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain 456006, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6525-1861","authenticated-orcid":false,"given":"Cecilia St\u00e5lsby","family":"Lundborg","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Health Systems and Policy: Medicines Focusing on Antibiotics, Karolinska Institutet, Tomtebodav\u00e4gen 18 A, 171 77 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.pop.2018.05.006","article-title":"Emergence of Global Antibiotic Resistance","volume":"45","author":"Morehead","year":"2018","journal-title":"Prim. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: A worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"ref_3","unstructured":"World Health Organization (2026, July 28). Global Action Plan on Antimicrobial Resistance. Available online: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/193736\/9789241509763_eng.pdf? sequence=1."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S0277-9536(02)00422-7","article-title":"Improving antibiotic use in low-income countries: An overview of evidence on determinants","volume":"57","author":"Radyowijati","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e18082","DOI":"10.7554\/eLife.18082","article-title":"Epidemiology and burden of multidrug-resistant bacterial infection in a developing country","volume":"5","author":"Lim","year":"2016","journal-title":"eLife"},{"key":"ref_6","unstructured":"World Health Organization (2021). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report, World Health Organization."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17416","DOI":"10.1038\/s41598-022-21423-w","article-title":"Prophylactic antibiotics for postcataract surgery endophthalmitis: A systematic review and network meta-analysis of 6.8 million eyes","volume":"12","author":"Kato","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.4103\/ijo.IJO_961_17","article-title":"Antibiotic prophylaxis in cataract surgery\u2014An evidence-based approach","volume":"65","author":"Haripriya","year":"2017","journal-title":"Indian J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/j.jcrs.0000000000000757","article-title":"Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2021 ASCRS member survey","volume":"48","author":"Chang","year":"2022","journal-title":"J. Cataract. Refract Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sharma, M., Eriksson, B., Marrone, G., Dhaneria, S., and Lundborg, C.S. (2012). Antibiotic prescribing in two private sector hospitals; one teaching and one non-teaching: A cross-sectional study in Ujjain, India. BMC Infect. Dis., 12.","DOI":"10.1186\/1471-2334-12-155"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Damlin, A., Sharma, M., Marrone, G., and Lundborg, C. (2020). Antibiotic prescribing among patients with severe infectious diseases in two private sector hospitals in Central India\u2014A time series analysis over 10 years. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05059-7"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pathak, A., Mahadik, K., Dhaneria, S.P., Sharma, A., Eriksson, B., and Lundborg, C.S. (2012). Surveillance of antibiotic consumption using the \u201cfocus of infection\u201d approach in 2 hospitals in Ujjain, India. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0038641"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Skender, K., Machowska, A., Dhakaita, S.K., Lundborg, C.S., and Sharma, M. (2024). Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: A prospective observational study. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-17817-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.ophtha.2010.05.020","article-title":"Prevalence of cataract in an older population in India: The India study of age-related eye disease","volume":"118","author":"Vashist","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Silfwerbrand, E., Verma, S., Sj\u00f6kvist, C., St\u00e5lsby Lundborg, C., and Sharma, M. (2019). Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.21203\/rs.2.12556\/v1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2146\/ajhp120568","article-title":"Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery","volume":"70","author":"Bratzler","year":"2013","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hailu, A.D., Workneh, B.D., and Kahissay, M.H. (2021). Influence of pharmaceutical marketing mix strategies on physicians\u2019 prescribing behaviors in public and private hospitals, Dessie, Ethiopia: A mixed study design. BMC Public Health, 21.","DOI":"10.1186\/s12889-020-10063-2"},{"key":"ref_18","first-page":"20","article-title":"Study of prescribing pattern of antimicrobial agents in medicine intensive care unit of a teaching hospital in Central India","volume":"60","author":"Badar","year":"2012","journal-title":"J. Assoc. Physicians India"},{"key":"ref_19","first-page":"15","article-title":"Antibiotic use in the intensive care unit","volume":"60","author":"Mangrulkar","year":"2012","journal-title":"J. Assoc. Physicians India"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1258\/td.2010.090157","article-title":"Antimicrobial drug use in a small Indian community hospital","volume":"40","author":"Blomberg","year":"2010","journal-title":"Trop. Doct."},{"key":"ref_21","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases (2012). LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, National Institute of Diabetes and Digestive and Kidney Diseases."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"396","DOI":"10.18203\/2319-2003.ijbcp20211022","article-title":"Drug utilization study in the ophthalmology department at a tertiary care hospital","volume":"10","author":"Ahluwalia","year":"2021","journal-title":"Int. J. Basic Clin. Pharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1075","DOI":"10.1016\/S2214-109X(17)30365-0","article-title":"Access, Watch, and Reserve antibiotics in India: Challenges for WHO stewardship","volume":"5","author":"McGettigan","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_24","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."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/0970-0218.62546","article-title":"Concept of essential medicines and rational use in public health","volume":"35","author":"Kar","year":"2010","journal-title":"Indian J. Community Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4103\/JPBS.JPBS_255_17","article-title":"Pharmacoepidemiological Observational Study of Antimicrobial Use in Outpatients of Ophthalmology Department in North Indian Population","volume":"10","author":"Kauser","year":"2018","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"367","DOI":"10.18203\/2319-2003.ijbcp20251062","article-title":"Study of prescription pattern of topical antimicrobials used for eye infections in ophthalmology","volume":"14","author":"Khan","year":"2025","journal-title":"J. Basic Clin. Pharmacol."},{"key":"ref_28","unstructured":"World Health Organization (2018). WHO Global Guidelines for the Prevention of Surgical Site Infection, World Health Organisation."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1155\/2004\/389092","article-title":"Measurement of antibiotic consumption: A practical guide to the use of the Anatomical Thgerapeutic Chemical classification and Defined Daily Dose system methodology in Canada","volume":"15","author":"Hutchinson","year":"2004","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_30","unstructured":"(2026, July 28). Ruxmaniben Deepchand Gardi Medical College. Available online: https:\/\/www.rdgmc.edu.in\/."},{"key":"ref_31","unstructured":"(2026, July 28). ATC-DDD Toolkit\u2014Defined Daily Dose (DDD): World Health Organisation. Available online: https:\/\/www.who.int\/toolkits\/atc-ddd-toolkit\/about-ddd."},{"key":"ref_32","unstructured":"World Health Organization (2019). International Statistical Classification of Diseases and Related Health Problems (ICD-10), World Health Organisation. Available online: https:\/\/icd.who.int\/browse10\/2019\/en."},{"key":"ref_33","unstructured":"World Health Organisation (2021). WHO ATC\/DDD Index 2021, World Health Organisation. Available online: https:\/\/www.whocc.no\/atc_ddd_index\/."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Saleh, H., Lundborg, C.S., and Sharma, M. (2025). Perceived benefits and barriers of medical doctors regarding electronic medical record systems in an Indian private-sector healthcare facility. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-025-12877-5"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e70404","DOI":"10.1002\/pds.70404","article-title":"The Role of Pharmacovigilance Database in Identifying Antibiotic Resistance and Inappropriate Use: An Analysis of VigiBase Reports from Lower-Middle-Income Countries","volume":"35","author":"Saleh","year":"2026","journal-title":"Pharmacoepidemiol. Drug Saf."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/8\/746\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:09:51Z","timestamp":1785510591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/8\/746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["antibiotics15080746"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15080746","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]}}}