The Study of Antibiotic Prescribing Patterns in a Tertiary Care Hospital

Background: Irrational antibiotic prescribing is a major contributor to antimicrobial resistance (AMR), and
tertiary care hospitals are among the largest consumers of antibiotics. Systematic evaluation of prescribing
practices using World Health Organization (WHO) core prescribing indicators is essential for strengthening
antimicrobial stewardship. This study assessed antibiotic prescribing patterns among inpatients at a tertiary
care hospital and evaluated the impact of a structured pharmacist-led counselling intervention.
Methods: A six-month prospective observational study was conducted among inpatients receiving antibiotic
therapy for at least 48 hours. A total of 384 prescriptions were included, based on a standard sample size
calculation (95% confidence level, 5% precision). Demographic, clinical, and prescription data were collected
and evaluated using WHO core prescribing indicators and the WHO Access, Watch, Reserve (AWaRe)
classification. Patients received structured counselling on rational antibiotic use, and changes in Knowledge.
Attitude, and Practice (KAP) were assessed before and after the intervention. Statistical analyses included
paired t-test, Student's t-test, and chi-square test, with p<0.05 considered statistically significant.
Results: Among 384 patients, 72% were male, with the highest proportion aged 46-60 years (27.1%). General
Medicine contributed the largest share of prescriptions (34.4%), followed by Surgery (22.4%) and the intensive
care unit (16.7%). Respiratory tract infections were the most common indication (29.2%). B-lactams (39.6%)
and fluoroquinolones (19.8%) were the predominant antibiotic classes. Oral administration, empirical
prescribing, and combination therapy were significantly more common than their respective alternatives
(p<0.001). Compared with WHO standards, the average number of drugs per encounter, antibiotic prescribing
frequency, and injection use exceeded recommended values, whereas generic prescribing and essential
medicines list adherence remained below target (p<0.05). Pharmacist-led counselling significantly improved
Knowledge (4.8±1.2 to 8.1±1.0), Attitude (5.1±1.3 to 8.3±0.9), and Practice (4.6±1.4 to 7.9±1.1) scores (all
p<0.001).