Pattern in the Antibiotic Prescribing Practices at Primary Health Settings in India: A Systematic Review and Meta-Analysis.

Antimicrobial resistance (AMR) is one of the main public health concerns in India, and it is stimulated through the uncontrolled overprescription of antibiotics within primary health care (PHC) centers. This systematic review and meta-analysis evaluate the usage pattern of antibiotics among Indian PHCs for prevalence, antibiotic type, and World Health Organization (WHO) access, watch, reserve (AWaRe) guidelines compliance. Following PRISMA 2020 guidelines, we systematically searched PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000-July 2025) for Indian PHC antibiotic prevalence studies. Observational and intervention studies with reported types and rates of prescriptions were considered for inclusion. Extraction was done by a standardized tool, and quality was evaluated by the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. Pooled prevalence of prescribing was estimated by random-effects meta-analysis, with subgroup analyses by region and setting. Eight studies incorporating more than 28,000 patient encounters reported a combined antibiotic prescribing prevalence of 65% (95% CI: 54-75%; I² = 92%). Broad-spectrum "Watch" antibiotics (e.g., fluoroquinolones, cephalosporins) prevailed, and there was suboptimal usage of "Access" (31.6%) antibiotics. Appropriate overprescribing occurred for the wrong infections, such as the upper respiratory tract infections (70-80%). Higher usage prevailed among northern compared with southern states (72% vs. 62%). Indian PHCs' overprescription of antibiotics because of system drivers necessitates urgent stewardship interventions, enhanced diagnosis, and AWaRe guideline adherence for addressing AMR.