Antibiotic Prescribing Practices and Adherence to ICMR Treatment Guidelines: A Narrative Review

Author

Anu Shashidhara, Shreyas Ramasamudra Venkatesha, Hithesh Saligrama Rudrachala, Harshith Gowda Mysore Nagendra, Sheba Baby John, Bettaswamy Huraliganaganahalli Vykuntappa, Hanumantachar Joshi

Abstract

  BACKGROUND:

Antimicrobial resistance is a growing public health concern, largely driven by inappropriate and unnecessary antibiotic use. Such practices can result in treatment failure, adverse effects, and higher healthcare costs. In India, antibiotic prescribing varies across healthcare settings, and despite ICMR efforts to promote rational use and antimicrobial stewardship, gaps in prescribing and guideline adherence persist due to diagnostic, resource, and implementation challenges.

OBJECTIVE: To synthesize evidence on antibiotic prescribing practices, adherence to ICMR treatment guidelines, gaps in rational prescribing, and the impact of antimicrobial stewardship interventions in Indian healthcare settings.

METHODOLOGY: A narrative review was conducted using PubMed, Google Scholar, and Scopus. Studies addressing antibiotic prescribing, ICMR guidelines, and antimicrobial stewardship in India were reviewed. A total of 18 eligible observational, cross-sectional, and prescription-audit studies were included and narratively synthesized.

RESULTS: The included studies showed considerable variation in guideline adherence. An ICMR multicenter evaluation of 4,838 prescriptions reported that 55.1% were guideline-concordant, while 9.8% showed unacceptable deviations. Complete adherence to the 4Ds of antimicrobial stewardship was 64.5%, with adherence ranging from 65% to 72% across drug selection, dose, route, and duration. Although 65% of hospitals had written prescribing guidelines, only 25% monitored antibiotic-use data and 30% conducted prescription audits with feedback. Major gaps included inadequate culture utilization, delayed de-escalation, and limited intravenous-to-oral conversion. Stewardship interventions improved appropriate prescribing from 66% to 86%, reduced antibiotic exposure per patient, and lowered antimicrobial costs by 14.4%.

CONCLUSION: Adherence to ICMR treatment guidelines remains inconsistent across Indian healthcare settings. Guidelines alone are insufficient to ensure rational antibiotic use. Strengthening sustainable, multidisciplinary antimicrobial stewardship through regular prescription audits, monitoring, feedback, diagnostic support, and prescriber education is essential to improve guideline adherence and promote rational antibiotic use in India.

Keywords

Antimicrobial stewardship; ICMR guidelines; antibiotic prescribing; rational antibiotic use; prescription audit; 4Ds; India.

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