Received: 03.06.2026
Accepted: 05.08.2026
Published online: 21.08.2026
UDC: 615.33:614.2
DOI: 10.53511/pharmkaz.2026.4.6
SYSTEMIC ANTIBIOTIC CONSUMPTION IN A MULTIDISCIPLINARY HOSPITAL ACCORDING TO THE WHO AWARE CLASSIFICATION
Zaru Sh. Kapassova¹, I.Z. Ismailov², M.A. Abuova³, G.M. Gurtskaya⁴,
K.M. Akpayeva¹, S.S. Kapassov¹, A.O. Amrenova¹
¹ Department of Pharmaceutical Disciplines, NJSC “Astana Medical University”, Astana, Republic of Kazakhstan.
² Institute of Chemistry and Phytotechnology, National Academy of Sciences of the Kyrgyz Republic,
Bishkek, Kyrgyz Republic.
³ Department of Pharmaceutical Supply and Preparation of Medicines, Multidisciplinary City Hospital No. 1,
Astana, Republic of Kazakhstan.
⁴ Multidisciplinary City Hospital, Astana, Republic of Kazakhstan.
Introduction. Rational use of antibacterial agents is a key component of strategies aimed at containing antimicrobial resistance. The World Health Organization (WHO) AWaRe (Access, Watch, Reserve) classification, combined with the ATC/DDD methodology, provides a standardized approach for assessing both the volume and structure of antibiotic consumption and identifying priorities for antimicrobial stewardship.
Objective. To analyze the structure and trends of systemic antibiotic consumption in a multidisciplinary hospital in Astana during 2022–2024 using the WHO ATC/DDD methodology and the WHO AWaRe classification, and to interpret the observed changes in the context of changes in the hospital’s clinical profile.
Materials and Methods. A retrospective observational study was conducted using aggregated, de-identified data from the hospital’s internal pharmacoepidemiological reporting system for 2022–2024. Consumption of systemic antibacterials classified under ATC group J01 was assessed according to the WHO ATC/DDD methodology and expressed as DDD per 100 bed-days. Antibiotics were categorized according to the WHO AWaRe classification. The five most frequently consumed international nonproprietary names and the seven leading ATC groups were additionally analyzed. Results were reported as absolute values and relative proportions without inferential statistical testing.
Results. Total systemic antibiotic consumption was 62.74 DDD/100 bed-days in 2022, 64.50 in 2023, and 52.33 in 2024. Watch antibiotics predominated throughout the study period, accounting for 62.67%, 63.89%, and 85.75% of total consumption, respectively. The proportion of Access antibiotics declined from 37.22% in 2022 to 36.02% in 2023 and 14.20% in 2024, whereas Reserve antibiotics remained below 0.2%. Ceftriaxone was the most frequently consumed antibiotic throughout the study period, increasing from 23.33 to 44.86 DDD/100 bed-days. At the ATC-group level, J01D consistently predominated, with consumption increasing from 25.76 to 47.58 DDD/100 bed-days.
Discussion. The persistently high proportion of Watch antibiotics and the decline in Access antibiotics to levels substantially below the WHO target of ≥60% highlight the need to strengthen antimicrobial stewardship and routine consumption monitoring. However, the pronounced shift observed in 2024 should be interpreted in the context of changes in the hospital structure, including the introduction of cardiovascular surgery, vascular surgery, and intensive care units, where the need for broader-spectrum antibacterial therapy may be greater. Thus, the observed consumption pattern likely reflects both prescribing practices and changes in the clinical case mix of the hospital.
Conclusion. Combined use of the WHO AWaRe classification and ATC/DDD methodology identified a persistent predominance of Watch antibiotics and an insufficient proportion of Access agents. Routine AWaRe-based monitoring adjusted for the clinical profile of hospital departments may support antimicrobial stewardship and optimization of antibacterial therapy in multidisciplinary hospitals.
Keywords: systemic antibiotics; WHO AWaRe; ATC/DDD; DDD per 100 bed-days; antimicrobial resistance; antimicrobial stewardship; ceftriaxone; multidisciplinary hospital; pharmacoepidemiology.
