Integrating Procurement, Prescription, and Resistance Data to Strengthen Antimicrobial Stewardship: Insights from a Public Health Institution in India

This study explored how antimicrobial procurement and prescribing practices relate to resistance trends in a public community hospital in India—an essential issue in low- and middle-income countries facing growing antimicrobial resistance (AMR). Using procurement data (2018–2022), outpatient prescriptions, and antibiotic susceptibility testing (AST) results (2023–2024), the study found that Amoxicillin–Clavulanate, Ciprofloxacin, and Doxycycline were the most procured drugs, with E. coli resistance rates of 53%, 87%, and 39%, respectively. Over half of outpatient prescriptions were for broad-spectrum antibiotics, and more than 90% were from the WHO AWaRe “Access” category, exceeding recommended proportions. Although overall correlations between procurement and resistance were weak, notable mismatches—such as frequent use of low-sensitivity drugs—revealed key stewardship gaps. As the first Indian study integrating procurement, prescription, and resistance data within one hospital, it highlights how institutional datasets can be leveraged to optimize antimicrobial use, revise formularies, and guide data-driven stewardship interventions.