Characteristics of empirical antibiotic therapy based on aware classification in patients with severe acute respiratory infections at Duc Giang General Hospital in 2023-2024
Main Article Content
Abstract
This study evaluated the empirical antibiotic therapy based on WHO’s AWaRe classification in 225 patients with Severe Acute Respiratory Infections at Duc Giang General Hospital from January 2023 to August 2024. The mean age of patients was 65 ± 16 years; common comorbidities were cardiovascular diseases (34.2%), chronic respiratory diseases (30.7%), and diabetes mellitus (21.8%). Monotherapy accounted for 53.3% of cases and 91.6% of antibiotics belonged to Watch group, predominatly third-generation cephalosporins. The rate of combination therapy was 46.7%, of which 90,5% of the primary antibiotics were also in Watch group while the most frequently combined antibiotics were levofloxacin (48.1%) and amikacin (21.2%). Only 16.7% of patients received appropriate antibiotics according to AWaRe guidelines. Although the group with adherence to AWaRe guidelines included more severe patients, no significant difference in clinical outcomes was observed
Article Details
Keywords
AWaRe, antibiotics, severe acute respiratory infection (SARI)
References
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15. Chowdhury F, Bhuiya S, Abdul Aleem M, et al. Decade-Long Trends in Antibiotic Prescriptions According to WHO AWaRe Classification Among Severe Acute Respiratory Infection Patients at Tertiary Hospitals in Bangladesh (2011-2020). Antibiotics. 2025; 14(2): 199. doi:10.3390/antibiotics14020199.
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19. Sulis G, Sayood S, Katukoori S, et al. Exposure to World Health Organization’s AWaRe antibiotics and isolation of multidrug resistant bacteria: a systematic review and meta-analysis. Clin Microbiol Infect. 2022; 28(9): 1193-1202. doi:10.1016/j.cmi.2022.03.014.
2. Green DA, Hitoaliaj L, Kotansky B, Campbell SM, Peaper DR. Clinical Utility of On-Demand Multiplex Respiratory Pathogen Testing among Adult Outpatients. McAdam AJ, ed. J Clin Microbiol. 2016; 54(12): 2950-2955. doi:10.1128/JCM.01579-16.
3. Palin V, Mölter A, Belmonte M, et al. Antibiotic prescribing for common infections in UK general practice: variability and drivers. J Antimicrob Chemother. 2019; 74(8): 2440-2450. doi:10.1093/jac/dkz163.
4. Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed Antimicrobial Therapy Increases Mortality and Organ Dysfunction Duration in Pediatric Sepsis: Crit Care Med. 2014; 42(11): 2409-2417. doi:10.1097/CCM.0000000000000509.
5. Bassetti MG Daniele R; Magnasco, Laura; Fantin, Alberto; Vena, Antonio; Castaldo, Nadia. Antibiotic Strategies for Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med. 2024; 45(02): 187-199. doi:10.1055/s-0043-1778641.
6. Olson G, Davis AM. Diagnosis and Treatment of Adults With Community-Acquired Pneumonia. JAMA. 2020; 323(9): 885. doi:10.1001/jama.2019.21118.
7. Hoàng H, Dương VS, Phạm ĐT, Phạm TQ. Đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị viêm phổi mắc phải cộng đồng ở người lớn tại Bệnh viện Phổi Thái Nguyên. Tạp chí Y học Việt Nam. 2024; 538(1). doi:10.51298/vmj.v538i1.9344.
8. Abdelsalam Elshenawy R, Umaru N, Aslanpour Z. WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance - a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic. Front Microbiol. 2023; 14: 1298858. doi:10.3389/fmicb.2023.1298858.
9. Moja L, Zanichelli V, Mertz D, et al. WHO’s essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections. Clin Microbiol Infect. 2024; 30: S1-S51. doi:10.1016/j.cmi.2024.02.003.
10. Community-level consumption of antibiotics according to the AWaRe (Access, Watch, Reserve) classification in rural Vietnam - PMC. Accessed November 16, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC7497401/.
11. Kolditz M, Ewig S. Community-Acquired Pneumonia in Adults. Dtsch Ärztebl Int. Published online December 8, 2017. doi:10.3238/arztebl.2017.0838.
12. Clinical care of severe acute respiratory infections - Tool kit. Accessed November 16, 2025. https://www.who.int/publications/i/item/clinical-care-of-severe-acute-respiratory-infections-tool-kit.
13. Charton L, Séverac F, Hansmann Y, Chambe J. Factors influencing inappropriate antibiotic prescription in respiratory tract infections in general practice. Sci Rep. 2025; 15(1): 33365. doi:10.1038/s41598-025-17490-4.
14. Đoàn NTM, Vũ VG, Nguyễn HPA, Đỗ V. Khảo sát việc điều trị viêm phổi mắc phải cộng đồng trên bệnh nhân nội trú tại Bệnh viện Bạch Mai từ 10/2022 đến 06/2023. Tạp chí Y học Việt Nam. 2023; 530(1B). doi:10.51298/vmj.v530i1B.6686.
15. Chowdhury F, Bhuiya S, Abdul Aleem M, et al. Decade-Long Trends in Antibiotic Prescriptions According to WHO AWaRe Classification Among Severe Acute Respiratory Infection Patients at Tertiary Hospitals in Bangladesh (2011-2020). Antibiotics. 2025; 14(2): 199. doi:10.3390/antibiotics14020199.
16. Fu M, Gong Z, Li C, et al. Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019. Lancet Reg Health - West Pac. 2023; 40:100880. doi: 10.1016/j.lanwpc.2023.100880
17. Antimicrobial consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2022. Accessed October 13, 2025. https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-consumption-europe-2022.
18. Dat VQ, Nguyen TH, Kim BG, Hieu QV, Otsu S. Capacity and use of diagnostics and treatment for patients with severe acute respiratory infections in the pre-COVID-19 era in district and provincial hospitals in Viet Nam. West Pac Surveill Response J. 2021; 12(4): 28-36. doi:10.5365/wpsar.2021.12.4.835.
19. Sulis G, Sayood S, Katukoori S, et al. Exposure to World Health Organization’s AWaRe antibiotics and isolation of multidrug resistant bacteria: a systematic review and meta-analysis. Clin Microbiol Infect. 2022; 28(9): 1193-1202. doi:10.1016/j.cmi.2022.03.014.