From Access to Watch: An AWaRe-Oriented Evaluation of Antibiotic Prescribing in ASL Salerno

Background/Objectives: The present study aimed to analyze systemic antibiotic prescription patterns in the Salerno Local Health Authority (ASL Salerno) during 2024. The objective was to describe territorial antibiotic consumption and monitor prescribing appropriateness from epidemiological, pharmacological, and antimicrobial stewardship perspectives, using the World Health Organization (WHO) AWaRe classification system as a reference. Methods: A retrospective analysis of antibiotic prescriptions was conducted across ASL Salerno in 2024. Total prescription and associated expenditures were assessed, along with distribution across districts and pharmacological classes. Antibiotics were categorized according to the Anatomical Therapeutic Chemical (ATC) system and further classified using the WHO AWaRe framework (Access, Watch, Reserve) to evaluate prescribing appropriateness and potential patterns of antimicrobial resistance. Results: More than 1 million antibiotic prescriptions were recorded, totaling approximately €15 million in expenditure. Prescribing patterns showed a predominance of penicillins and cephalosporins, followed by macrolides, fluoroquinolones, and J01X class. A substantial proportion of prescriptions belonged to the Watch category, particularly third-generation cephalosporins, fluoroquinolones, and fosfomycin. Some districts demonstrated a higher reliance on Watch antibiotics, while others showed increased use of Access agents such as amoxicillin, doxycycline, and amikacin. Conclusions: The surveillance analysis highlights significant variability in antibiotic prescribing practices within ASL Salerno and a substantial use of Watch-group antibiotics. These findings suggest the need for strengthened antimicrobial stewardship interventions, such as targeted education, auditing, and decision-support tools. Continuous monitoring of prescribing trends is essential to encourage appropriate antibiotic use and contribute to the containment of antimicrobial resistance.