Importance of hospital-specific antibiotic policy for ensuring maternal quality of care in India: A narrative review.

Abstract

Maternal health is pivotal in India, where infections significantly drive maternal morbidity and mortality. While antibiotics are essential for preventing sepsis, neonatal Group B Streptococcus, and surgical site infections (SSI), their misuse-fueled by empirical prescribing, self-medication, and over-the-counter access-has escalated antimicrobial resistance (AMR). This challenge is compounded by India's high maternal mortality, uneven healthcare resources, and cultural practices. Tailored, hospital-specific antibiotic policies, grounded in local epidemiology, resistance patterns, and resources, are critical to optimizing use and enhancing care quality. This narrative review synthesized National (ICMR, NCDC) and International (WHO, ACOG) guidelines, local resistance data, antibiograms. epidemiological studies, and stewardship interventions related to maternal infections. Key sources included the WHO AWaRe antibiotic classification and local antibiograms. Antibiotics are classified into first, second and third-line treatments for various obstetric conditions and treatments based on patient demographics, resources, and resistance patterns, with ongoing policy evaluation adapted to hospital-specific needs. Recommendations were adapted to local resistance patterns, resource availability, and patient demographics. Excessive antibiotic use exacerbates AMR and adverse outcomes, but hospital-specific policies prioritizing narrow-spectrum agents, guided by local antibiograms shown less complications. Incorporating stewardship measures (e.g., prophylaxis criteria, formulary restrictions, audits, and education) improved guideline adherence, curbed broad- spectrum use, and bolstered neonatal safety. Implementing hospital-specific antibiotic policies effectively reduces infection rates and improves maternal-neonatal outcomes through standardized regimens prioritizing narrow-spectrum antibiotics and utilizing local antibiograms. Key stewardship strategies included defined prophylaxis protocols, formulary restrictions, and ongoing education, all contributing to enhanced maternal and neonatal safety. Hospital-specific antibiotic policies provide an evidence-based framework for optimizing antibiotic use in obstetrics by aligning national and international guidelines with local epidemiological and resistance data. These tailored policies strengthen antimicrobial stewardship and clinical decision-making, mitigate AMR, and improve maternal and neonatal outcomes. Implementing such frameworks in India's diverse healthcare landscape is vital to safeguarding treatment efficacy, improving outcomes amid rising resistance and effective maternal healthcare delivery in India.