Practical insights from implementing a national programme for monitoring appropriateness of antimicrobial prescribing in the South-East Asia Region: experience from the CAPTURA project in Bangladesh, Bhutan, and Nepal.

OBJECTIVES

Surveillance of antimicrobial prescribing quality is a core element of national antimicrobial resistance containment strategies. The National Antimicrobial Prescribing Survey (NAPS) programme was implemented in Bangladesh, Bhutan, and Nepal under the Fleming Fund-supported Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia project to strengthen national surveillance and stewardship capacity. The programme comprises setting-specific modules using standardized indicators including documentation quality, guideline concordance, and appropriateness.

METHODS

Between September 2024 and September 2025, Hospital NAPS point-prevalence audits were conducted in Bangladesh and Nepal, and Surgical NAPS was piloted in Bhutan. Audits were conducted in two phases to enable local interventions between rounds, incorporating stakeholder engagement, structured auditor training, and central quality assurance.

RESULTS

Ten hospitals completed audits encompassing 1299 patients (Hospital NAPS), 236 procedures (Surgical NAPS), and 2308 prescriptions. The programme produced baseline prescribing appropriateness data for the first time to inform stewardship priorities across district to tertiary settings. Key enablers included national engagement and establishment of antimicrobial stewardship committees; barriers included incomplete documentation, infrastructure limitations, and coordination challenges.

CONCLUSION

The NAPS programme demonstrated feasibility across diverse health system contexts in three South-East Asia Region countries. Sustained leadership, routine practice integration, local ownership, and committed cross-institutional collaboration are critical for long-term stewardship impact.