Comparative assessment of antibacterial drugs used at the hospital level before and during COVID-19, according to the WHO AWaRe classification
Balapasheva A.A. Smagulova G.A. Mussina A.Z. Dilmagambetov D.S. Yermekbayeva K.Z. Kelimberdiev M.S. Kulnazarova M.S. Balymbetova L.S. Ziganshina L.E.
2025Frontiers Media SA
Frontiers in Pharmacology
2025#16
Antimicrobial resistance is a major global challenge, and the World Health Organization (WHO) promotes the Access, Watch, and Reserve (AWaRe) classification to support rational antibiotic use. In Kazakhstan, irrational prescribing remains common, and the COVID-19 pandemic intensified the misuse of broad-spectrum antibiotics. A retrospective study at a hospital in Aktobe (2019–2021) analyzed antibiotic use from pharmacy and medical records using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology, with categorization by the WHO AWaRe classification. The analysis revealed a persistent predominance of “Watch” antibiotics, particularly cephalosporins, fluoroquinolones, and carbapenems, with their use intensifying during the COVID-19 pandemic. The share of “Access” antibiotics remained well below the WHO-recommended target of 60%, fluctuating between 24% and 27% across the study period. Reserve antibiotics were not prescribed. The findings reveal gaps in antibiotic stewardship in Kazakhstan: overreliance on “Watch” antibiotics and underuse of “Access” drugs, contrary to WHO guidance. Implementing the AWaRe framework with national targets and monitoring is essential, and the study adds regional evidence to the global AMR discourse, underscoring the need for stronger policies, especially during pandemics. Copyright
antibacterial drugs , antibiotic consumption , antibiotics , AWaRe , COVID-19 , world health organization
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Department of Pharmacology, Clinical Pharmacology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Otorhinolaryngology, Ophthalmology, Phthisiology and Dermatovenereology Department, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Deparment of Surgical Diseases No 1, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
Department of Hospital Epidemiology, Medical Parasitology and Tropical Diseases, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
Department of General and Clinical Pharmacology, Рeoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University named after Patrice Lumumba), Moscow, Russian Federation
Department of Pharmacology, Kazan State Medical University, Kazan, Russian Federation
Department of Pharmacology
Department of Otorhinolaryngology
Deparment of Surgical Diseases No 1
Department of Hospital Epidemiology
Department of General and Clinical Pharmacology
Department of Pharmacology
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