Assessment of antibiotic prescribing patterns at dental and primary health care clinics according to WHO Access, Watch, Reserve (AWaRe) classification


      • Prescribing of Watch-group antibiotics was evidently high and requires close monitoring.
      • Second-generation cephalosporins and macrolides were the frequently prescribed Watch-group antibiotics.
      • Antibiotic prescribing practice was inappropriate and adherence to clinical guidelines was poor.



      The 2019 WHO Access, Watch, Reserve (AWaRe) classification antibiotic classification framework aims to prevent irrational prescribing of antibiotics used to treat widespread infections. This study explored antibiotic prescribing pattern for appropriate indications by family physicians and general dentists in primary healthcare practices.


      A retrospective review of patients’ electronic medical records was conducted over six months, from May 1, 2020, to November 30, 2020. The data were collected from 24 general family medicine and dental practices within the North West Armed Forces in Tabuk city. Antibiotic prescribing for systemic use (J01) was assessed by the number of prescriptions and the number defined daily doses (DDDs) and then analyzed according to the AWaRe classification. The prescribing of antibiotics for appropriate indications was assessed through comparing the prescription pattern with the recently published and relevant clinical guidelines. Multivariate logistic regression analysis was used to predict the association between the prescribing of AWaRe category and some demographic and disease-related factors.


      In total, 752 prescriptions of antibiotics were collected. Watch-group antibiotics such as second-generation cephalosporin and macrolide were more likely prescribed (51.1%) based on the number of prescriptions and (52.2 %) based on DDDs compared with Access-group antibiotics (48.9%) and (47.8%), respectively. The percentages of Watch group antibiotics for children and adults were 66.7% and 42.9%, respectively. Adherence to prescribing guidelines was poor for children (27.2%) and adults (64%). Being a child (adjusted OR: 2.89; 95% CI = 1.46–5.78), diagnosis with acute respiratory tract infection (adjusted OR, 2.62; 95% CI = 1.03–6.69), and urinary tract infection (adjusted OR, 4.69; 95% CI = 2.09–10.56) were associated with higher prescriptions of Watch-group antibiotics.


      a higher prescribing of Watch-group antibiotics and poor adherence to antibiotic guidelines were observed, especially for children. The findings of this study identified targets for further improvement and interventions needed to develop better antibiotic-prescribing practices.


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