WHO Prescribing Indicators and AWaRe Classification of Antibiotics in Two Primary Healthcare Centers in Alexandria, Egypt

Background: Irrational drug use is common in developing countries, leading to poor healthcare services. Appropriate use of drugs in five key areas can be measured using the WHO prescribing indicators. Additionally, the WHO developed the AWaRe tool to prevent and monitor inappropriate antibiotic use. Objective(s): The study aims to assess drug prescribing patterns in Primary Healthcare Centers (PHC) in Alexandria using the WHO prescribing indicators and the AWaRe classification of antibiotics. Methods: The study was conducted at two PHC in the East and El-Gomrok Districts of Alexandria governorate, Egypt. A cross-sectional study was performed, including all prescriptions written by family physicians in the PHC centers of the East District (1,090 prescriptions) and El-Gomrok District (488 prescriptions) during a one-month period (September 2023). Results: The average number of drugs per prescription was 2.5 ± 1.08 in both the East and El-Gomrok District centers. The average percentage of prescriptions containing antibiotics was 19.8%, and the percentage containing injections was 12.1%. Almost all prescriptions were written using generic names and included drugs from the Essential Drug List (EDL). El-Gomrok District center had the highest Index of Rational Drug Prescribing (IRDP). The highest consumption of antibiotics was from the “Access” group of the AWaRe classification (antibiotics used as first- and second-line treatments for infections) (85.7% in the East District center and 91.6% in the El-Gomrok District center). No antibiotics were prescribed from the “Reserve” group (antibiotics used for infections resistant to many drugs) or the “Not Recommended” group (antibiotics not supported by evidence or recommended guidelines). Conclusion: All prescribing indicators, except for the average number of drugs per prescription and the percentage of prescriptions containing injections, were within the optimal value of WHO. The El-Gomrok District center exhibited the highest performance in rational drug use according to the IRDP index. Results revealed adherence to the AWaRe antibiotic classification criteria.