Analysis of the use of antibiotics by AWaRe categories during the COVID-19 pandemic in hospitals across Scotland: a national population- based study Euan Proud , 1,2 Tanja Mueller, 1,3 Karen Gronkowski, 1 Amanj Kurdi, 1,3,4 Niketa Platt, 1 Aidan Morrison, 1 Marion Bennie, 1,3 William Malcolm 1 Original research
ABSTRACT Objective The Access, Watch and Reserve (AWaRe) list of antibiotics was developed by the WHO to support antibiotic stewardship programmes (ASP). The Access group incorporates first-line options, while Watch antibiotics have higher resistance potential or toxicity, and Reserve drugs should be used only for complex infections. ASP implementation has been challenged during the COVID-19 pandemic. There is a knowledge gap regarding in-hospital prescribing patterns of antibiotics nationally during the COVID-19 pandemic, and on the characteristics of hospitalised patients prescribed antibiotics during this time. We aimed to evaluate quality of antibiotic use according to AWaRe classification in Scottish hospitals, including assessing the impact of COVID-19 on trends. Methods Cross-sectional study of antibiotics prescribed to hospitalised patients from 1 January 2019 to 30 June 2022 in a selection of Scottish hospitals, covering approximately 60% (3.6 million people) of the Scottish population. Data were obtained from the Hospital Electronic Prescribing and Medicines Administration system. Prescribing trends were explored over time, by age and by sex. Results Overall, a total 1 353 003 prescriptions were identified. An increase in Access antibiotics was found from 55.3% (31 901/57 708) to 62.3% (106 449/170 995) over the study period, alongside a decrease in Watch antibiotics from 42.9% (24 772/57 708) to 35.4% (60 632/170 995). Reserve antibiotic use was limited throughout, with minor changes over time. Changes in prescribing were most pronounced in the older age group (>65 years): proportions of Access antibiotics increased from 56.4% (19 353/34 337) to 65.8% (64 387/97 815, p<0.05), while Watch antibiotics decreased from 41.9% (14 376/34 337) to 32.3% (31 568/97 815, p<0.05) between Q1 2019 and Q2 2022. Differences between males and females were insignificant. Conclusions Findings showed encouraging trends in Access and Watch use among hospitalised patients, in line with Scottish national standards. There was no noteworthy effect of COVID-19 on prescribing trends despite reports indicating stewardship programmes being negatively impacted by the pandemic.
► Additional supplemental material is published online only. To view, please visit the journal online (https:// doi.org/10.1136/ejhpharm- 2023-003874). 1 Public Health Scotland Glasgow Office, Glasgow, UK 2 Pharmacy, NHS Forth Valley, Stirling, UK 3 University of Strathclyde, Glasgow, UK 4 Department of Pharmacology, Hawler Medical University, Erbil, Iraq Correspondence to Euan Proud, Public Health Scotland Glasgow Office, Glasgow G2 6QE, UK; euan. proud2@phs.scot Received 12 June 2023 Accepted 23 January 2024 EAHP Statement 4: Clinical Pharmacy Services.
INTRODUCTION Antimicrobial resistance (AMR) is one of the biggest threats to health globally, complicating the treat- ment of common infections and increasing dura- tion of illness, mortality rates and treatment costs. 1 Modifiable drivers of AMR include the overuse and misuse of antimicrobials, including unwarranted use of broader spectrum antibiotics and unneces- sarily prolonged antibiotic courses. 2 The WHO compiled a list of 180 commonly used antibiotics and categorised these into the Access, Watch and Reserve (AWaRe) classification system. 2 The Access group consists of first-choice agents for common infections, generally with narrower spec- trums of action. The Watch group contains antibiotics more commonly used as second-line treatments, or for treating resistant organisms. Finally, the Reserve group contains antibiotics considered drugs of last resort, when no other options are available, for example, in extensively drug-resistant infections. The AWaRe list requires local adaption given geographical WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Antimicrobial prescribing should primarily be from the WHO Access class to minimise the risk of developing resistance and preserve broader spectrum antibiotics. There is conflicting evidence around the quality of prescribing of antibiotics in hospitals during the COVID-19 pandemic. WHAT THIS STUDY ADDS ⇒ This study adds value in its duration (prepandemic, during and in the recovery phase), large sample size and patient-level data. This study showed COVID-19 did not appear to detrimentally effect the quality of prescribing with any increase in the proportion of broader spectrum antibiotics being prescribed and Reserve antibiotic use remained reassuringly low throughout the pandemic. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Further research could include data on the indication for antibiotics which was not available here and incorporate both primary care and hospital data together.
To cite: Proud E, Mueller T, Gronkowski K, et al . Eur J Hosp Pharm Epub ahead of print: [ please include Day Month Year]. doi:10.1136/ ejhpharm-2023-003874 © European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.
Proud E, et al . Eur J Hosp Pharm 2024; 0 :1–4. doi:10.1136/ejhpharm-2023-003874
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