Antibiotic Prescribing Patterns among Outpatients According to the WHO’s AWaRe (Access, Watch, Reserve) Classification at Chiúre District Hospital, Cabo Delgado, Mozambique

Background: The inappropriate use of antibiotics is one of the main factors associated with the rise in antimicrobial resistance, which the World Health Organisation considers to be one of the greatest threats to global public health. To promote the rational use of these medicines, the WHO has developed the AWaRe classification (Access, Watch and Reserve), which provides guidance on the prescription of antibiotics according to their potential to induce resistance and their therapeutic importance.
Objective: To assess antibiotic prescribing patterns among outpatients using the World Health Organisation’s AWaRe classification at Chiúre District Hospital, located in Cabo Delgado Province, Mozambique.
Methods: A retrospective study was conducted based on the analysis of secondary data from the medical records of patients treated on an outpatient basis between March and September 2025. A total of 449 prescriptions from patients of different age groups were analysed. The prescriptions were assessed using the WHO’s AWaRe classification and the WHO/INRUD Prescribing Indicators. Statistical analyses were conducted using descriptive statistics with the R software.
Results: Of 449 patients, 33.6% were aged under 5 years, with a balanced sex distribution. Amoxicillin (40.8%), co-trimoxazole (26.2%), and metronidazole (8.3%) were the most prescribed antibiotics. Respiratory conditions were the most frequent diagnosis (39.3%). Most prescriptions were from the Access group (86.9%), followed by Watch (11.7%) and unclassified agents (1.5%).
Conclusion: Antibiotic prescribing was largely aligned with WHO AWaRe recommendations, with a predominance of Access antibiotics. However, the use of Watch antibiotics and gaps in clinical documentation indicate opportunities to strengthen prescribing oversight, professional training, and record-keeping to support rational antibiotic use.

Antimicrobial resistance; Antibiotics; AWaRe classification; Rational prescribing

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