Antibiotic Stewardship Program at a Tertiary Care Academic Hospital: A Comprehensive Analysis of an Audit Across Various Specialties

Introduction Antimicrobial resistance (AMR) is a growing global health concern, largely driven by inappropriate antibiotic use in hospital settings. Antimicrobial stewardship programs (AMSPs) are essential to promote rational antibiotic prescribing; however, variability in implementation and adherence across specialties remains a challenge. Periodic audits are critical for assessing prescribing practices and identifying areas for improvement. This study was conducted to evaluate the implementation of an AMSP at a tertiary care academic hospital through a cross-specialty audit of antibiotic use. Methods A cross-sectional audit of 800 patient records from January to December 2023 was conducted across multiple specialties. Antibiotic prescribing patterns, adherence to institutional guidelines, and classification according to the WHO Access, Watch, and Reserve (AWaRe) framework were analyzed. Comparisons were made between medical and surgical specialties. Results The overall antibiotic prescription rate was 88.1% (705/800 cases), with significant variation across departments. Ophthalmology demonstrated 100% adherence to institutional guidelines (100/100 cases), whereas Medicine and Pediatrics showed comparatively lower adherence (45/100 (45%) and 40/100 (40%), respectively). De-escalation practices were suboptimal, particularly in critical care settings. Watch group antibiotics predominated across both specialties, and a statistically significant difference in AWaRe distribution between medical and surgical departments was observed (p = 0.003). Surgical departments exhibited significantly higher adherence to institutional antibiotic guidelines compared with medical departments (330/400 (82.5%) vs 278/400 (69.6%), p < 0.001). They also prescribed fewer antibiotics per patient (mean 1.18 ± 0.5 vs 1.43 ± 0.6, p < 0.001) and had shorter durations of antibiotic therapy (3.91 ± 1.1 vs 4.25 ± 1.2 days, p < 0.001). Conclusion AMSP implementation has led to improvements in antibiotic prescribing practices; however, important specialty-specific gaps persist, particularly in medical and critical care settings. The high use of Watch group antibiotics and limited de-escalation highlight the need for strengthened stewardship efforts. Targeted interventions, regular audit and feedback, and the development of specialty-specific guidelines are essential to optimize antibiotic use and sustain the impact of stewardship programs.