Integrating Procurement, Prescription, and Resistance Data to Strengthen Antimicrobial Stewardship: Insights from a Public Health Institution in India

Vinay Modgil¹Sundeep Sahay^2*Arunima MUKHERJEE²Rashi Banta¹Neha Joshi¹Rashmi Surial¹Subhash Thakur¹Suvodeep Mazumdar³Sneha Roychowdhury³Neelam Taneja⁴

• ¹HISP India, india, India
• ²University of Oslo, Oslo, Norway
• ³The University of Sheffield, Sheffield, United Kingdom
• ⁴Post Graduate Institute of Medical Education and Research, Chandigarh, India

Sustained and sub-optimal antimicrobial use drives antimicrobial resistance (AMR), a major health systems challenge in low-and middle-income countries (LMICs) such as India. This study examined the relationship between institutional antimicrobial procurement and outpatient prescribing patterns, and how these influence resistance trends identified through antibiotic susceptibility testing (AST) in a public community hospital. Data were collected from three sources: (i) procurement records (2018–2022), (ii) AST results from urine, pus, and stool samples (2023–2024), and (iii) outpatient prescriptions (2023–2024). Each dataset was analyzed individually and in an integrated framework to assess inter-relationships between antimicrobial use and resistance. Amoxicillin–clavulanate, ciprofloxacin, and doxycycline were among the most procured drugs, with E. coli (urine) resistance rates of 53%, 87%, and 39%, respectively. The most frequently prescribed antimicrobials were Amoxicillin–Clavulanate (24%), Cefixime (15%), and Azithromycin (11%); over 50% were broad-spectrum agents and over 90% belonged to the WHO AWaRe "Access" category, exceeding global recommendations. Correlation analysis revealed a weak positive association between procurement and sensitivity, indicating that higher procurement did not necessarily increase resistance. However, specific mismatches, such as high prescription of low-sensitivity drugs, highlighted critical stewardship gaps. To our knowledge, this is the first study from India integrating procurement, prescription, and AST data within a single public hospital. These findings demonstrate the feasibility of linking institutional datasets to identify inefficiencies in antimicrobial use and guide evidence-based stewardship interventions, including formulary revision, procurement alignment, and data-driven prescribing practices.