Background Antimicrobial resistance (AMR) is a major global threat, driven by the misuse and overuse of antimicrobials. India faces unique challenges in combating AMR due to the absence of a national antimicrobial stewardship program (ASP). This study aimed to evaluate antimicrobial use in a general surgery ward using the metrics Defined Daily Dose (DDD) and Days of Therapy (DOT). Methods A prospective study was conducted over six months in the surgery wards of a tertiary care hospital. Of the 554 admitted patients, 217 (29.16%) were included in the study. Of these, 125 (57.60%) were male and 92 (42.40%) were female. The mean age and length of stay were 47.2 ± 16.66 years and 7.03 ± 3.25 days, respectively. Antimicrobial usage was measured using DDD and DOT per 1000 patient-days. The difference between DDD and DOT was analyzed using the Wilcoxon signed-rank test. Results The mean total antimicrobial usage was 6273.919 ± 7842.411 DDDs per 1000 patient-days and 4491.776 ± 1665.571 DOTs per 1000 patient-days. Among the 36 commonly used antimicrobials, the difference between DDD and DOT was classified as major [24 (77.42%)], moderate [5 (16.13%)], and minor [7 (22.58%)]. The Length of Therapy (LOT) was 8271.89 per 1000 patient-days, while the antimicrobial resistance rate was 9.21%. Conclusions The study identified significant discrepancies between DDD and DOT, underscoring the need to use multiple metrics to evaluate antimicrobial stewardship programs. Clinical pharmacists play a key role in monitoring antimicrobial use to mitigate resistance.

Objective: To evaluate rational drug prescribing practices in the surgical wards of a tertiary care hospital using World Health Organization/ International Network of Rational Use of Drugs (WHO/INRUD) prescribing indicators. Methods: A prospective observational study was conducted in general surgery wards of a tertiary care hospital over a six-month period. A total of 249 patients aged ≥ 18 years, with a hospital stay exceeding 24 hours were included. Data on drug prescriptions, including dose, frequency, and type, were collected from patient case notes and treatment charts. WHO/INRUD prescribing indicators were used to assess; average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of patient encounters with antibiotics and injections, and percentage of drugs from the national essential drug list (NEML). Results: The average number of drugs per encounter was 9.26, significantly exceeding the optimal level of ≤3. Only 14.22% of drugs were prescribed by generic name. Antibiotics were prescribed in 99.53% of encounters, far above the WHO-recommended 30%. The percentage of encounters with injectable drugs was 85.14%, and drugs from the NEML constituted 63.50%. Conclusions: The study reveals substantial deviations from WHO guidelines, with high rates of polypharmacy, low generic prescribing, and excessive antibiotic use. These practices heighten the risk of antimicrobial resistance (AMR) and underscore the need for effective antimicrobial stewardship programs. Hospitals should implement multifaceted strategies to improve antimicrobial use and align with WHO recommendations.