An Observational Study to Evaluate the Antibiotic Prescribing Pattern Using Who Access, Watch, Reserve (Aware) Criteria Among Pediatric Patients Admitted In Intensive Care Unit At Sir Padampat Institute Of Neonatology & Paediatric Health, Jaipur

Abstract

Background: Escalating antimicrobial resistance (AMR) threatens the effectiveness of life saving antibiotics, particularly in low and middle income countries. The World Health Organization (WHO) introduced the Access, Watch, Reserve (AWaRe) framework to monitor and optimise antibiotic use. Robust paediatric data remain scarce, especially for Indian intensive care settings. Methods: We performed a descriptive, hospital based observational study of consecutive new admissions to the Paediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) at Sir Padampat Institute of Neonatology & Paediatric Health (SPINPH), Jaipur. All children receiving at least one antibiotic were enrolled until the target sample of 400 was achieved (95 % CI, 10 % relative error). Prescriptions were analysed for drug, dose and adherence to Standard Treatment Guidelines (STG, 6th edition). Each molecule was mapped to the WHO AWaRe list (2021). Primary outcomes were the proportions of antibiotics in the Access, Watch and Reserve groups. Secondary outcomes included adverse drug reaction (ADR) incidence and culture-confirmed resistance patterns. Data were summarised as means ± SD or proportions; χ² and paired t tests were applied as appropriate. Results: A total of 400 children (male: female = 2.1: 1; mean age 2.6 ± 3.6 years) received 838 antibiotic (mean 2.09 ± 0.63 per encounter). Watch agents predominated (65.2 %), surpassing Access (32.5 %) and Reserve (2.4 %) drugs (Figure 1). Amikacin (Access) was most frequent (22.7 % of all prescriptions), whereas cefotaxime and vancomycin led the Watch category (19.3 % and 16.0 %, respectively) (Figure 2). Ninety-seven per cent of agents were on the Indian Essential Medicines List and were prescribed generically. Adherence to STG exceeded 85 % for nine major drugs but fell below 60 % for azithromycin, aztreonam, linezolid and teicoplanin. Culture results were available for only 4.8 % of cases, isolating Pseudomonas spp. (32 %), Acinetobacter spp. and E. coli (each 21 %). ADRs occurred in 5 % of children, mostly mild, with no fatalities. Conclusion: Two-thirds of antibiotic use in this ICU/NICU cohort derived from the Watch group, underscoring an urgent stewardship need to shift prescribing towards Access agents. Limited microbiological testing hampers rational escalation/de escalation. Implementing real-time culture surveillance and AWaRe-based feedback could curb unnecessary exposure to broad-spectrum antibiotics and mitigate AMR.