Antibiotic Prescription Patterns for Respiratory Infections in Urban Outpatient Settings in India: A Multicenter, Retrospective, EMR-Based Study Using WHO AWaRe Classification

Introduction: The emergence of antimicrobial resistance represents an escalating worldwide challenge, with developing nations like India experiencing heightened vulnerability due to substantial prevalence of communicable diseases coupled with widespread inappropriate antimicrobial utilization. Despite the growing adoption of electronic medical record (EMR) systems, their potential for AMR surveillance remains underutilized. Methods: In this multicenter, retrospective observational study, we analyzed anonymized EMR data from 183,608 outpatient prescriptions for respiratory system infections in seven major metropolitan cities in India, collected between January 2021 and December 2023. Results: Antimicrobials agents were utilized in 59,779 (32%) cases, with a significant majority (85%) classified under the WHO AWaRe “Watch” category. Azithromycin (28.09%), cefpodoxime proxetil (19.07%), and cefixime (13.61%) represented the most prescribed agents, while acute upper respiratory infections comprised (40.6%) of diagnoses linked to antimicrobial prescribing. Conclusion: These observations emphasize the critical requirement for strengthened antimicrobial stewardship through strict compliance to WHO AWaRe recommendations to limit the broad-spectrum antimicrobial overutilization and mitigate AMR. Comprehensive antibiotic policies, regionally tailored strategies, and enhanced EMR-based surveillance are critical to fostering rational antibiotic use and reducing AMR rates in India.