Generating evidence on antibiotic use across human and animal health sectors using the World Health Organization’s Access, Watch, Reserve (AWaRe) classification: Exploratory pilot study in rural Pune, India

Research (Published online: 22-12-2023)

14. Generating evidence on antibiotic use across human and animal health sectors using the World Health Organization’s Access, Watch, Reserve (AWaRe) classification: Exploratory pilot study in rural Pune, India

Abhay Machindra Kudale, Sakshi Shantanu Hiralkar, Pravin Arun Sawant, Yogita Purushottam Hulsurkar, Nikhil Rajkumar Fatate, Priya Padmakar Waghmare, Abhishek Prakash Randive, Mugdha Sharad Phutane, Prashant Pawar, and Prashant Mhase

International Journal of One Health, 9(2): 166-171

Abhay Machindra Kudale: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Sakshi Shantanu Hiralkar: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Pravin Arun Sawant: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Yogita Purushottam Hulsurkar: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Nikhil Rajkumar Fatate: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Priya Padmakar Waghmare: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Abhishek Prakash Randive: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Mugdha Sharad Phutane: Department of Health Sciences, School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.

Prashant Pawar: Departments of Veterinary Parasitology and Microbiology, KNP College of Veterinary Science, Satara, Maharashtra Animal and Fishery Sciences University, Nagpur, Maharashtra, India.

Prashant Mhase: Departments of Veterinary Parasitology and Microbiology, KNP College of Veterinary Science, Satara, Maharashtra Animal and Fishery Sciences University, Nagpur, Maharashtra, India.

doi: 10.14202/IJOH.2023.166-171

Article history: Received: 11-07-2023, Accepted: 16-11-2023, Published online: 22-12-2023

Corresponding author: Abhay Machindra Kudale

E-mail: abhay.kudale@gmail.com

Citation: Kudale AM, Hiralkar SS, Sawant PA, Hulsurka YP, Fatate NR, Waghmare PP, Randive AP, Phutane MS, Pawar P, and Mhase P (2023) Generating evidence on antibiotic use across human and animal health sectors using the World Health Organization’s Access, Watch, Reserve (AWaRe) classification: Exploratory pilot study in rural Pune India, Int. J. One Health, 9(2): 166-171.

Abstract

Background and Aim: Human antibiotic formulations in animal feed for therapeutic and non-therapeutic purposes have contributed to antimicrobial resistance worldwide; however, little evidence is available in low- and middle-income countries. We aimed to generate evidence of antibiotic use across the human and animal health sectors by investigating the overlap in antibiotic use in community settings in rural blocks of Pune District, India, following the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification.

Materials and Methods: An exploratory pilot study using a cross-sectional design in two randomly selected rural blocks of the Pune district included 138 interviews with general physicians (GPs, n = 62), pharmacists (n = 60), and veterinary practitioners (n = 16) using semi-structured interview schedules and the WHO AWaRe classification. IBM-Statistical Package for the Social Sciences, Version 21.0 software was used for descriptive statistics and to calculate the proportions of the different antibiotic groups. The WHO AWaRe classification was used to describe antibiotic use by the study participants and to assess the overlap in antibiotic use.

Results: Our study provides evidence of an overlap in human and animal antibiotic use in rural community settings across the human and animal health sectors. Amoxicillin (access group), penicillin (access group), and ofloxacin (watch group) were used in both human and animal health. Amoxicillin and penicillin were used to treat common bacterial infections, ofloxacin was used to treat skin infections in humans and animals, and ofloxacin was used to treat pneumonia in animals and urinary bladder infections in humans. In contrast, azithromycin (watch group), cefixime (watch group), and amoxicillin (Access Group), with or without other antibiotics, were the most commonly used antibiotics by GPs in humans.

Conclusion: We confirmed the overlap in antibiotic use across the human and animal health sectors in rural community settings, suggesting the need for interventions following the One Health approach. Further, research is required to assess the patterns of this overlap, as well as behavior, knowledge, and potential solutions to help avoid this overlap and prevent the rampant use of antibiotics in the animal and human health sectors in rural community settings.

Keywords: antimicrobial resistance, antibiotics use, overlap, rural India, WHO AWaRe.