<![CDATA[Antimicrobial resistance (AMR) has become a significant public health issue in Pakistan due to its poor regulations, lack of infection prevention and control measures, and empirical prescription practices. The objectives of this study were to evaluate antimicrobial use (AMU), prescribing practices, WHO AWaRe categorization, and factors related to AMU in hospitalized patients. A cross-sectional study was conducted based on WHO Point Prevalence Survey technique in April 2025 in 10 public and private tertiary care hospitals in four different regions of Pakistan. The data of 969 inpatients were statistically evaluated using SPSS software version 29. The ethical clearance was taken from National Institutes of Health, Pakistan. In general, antimicrobials were prescribed to 94% of patients in both public (94%) and private (95%) hospitals. The AMU was found 100% in intensive care unit, neonates, maternity, and pediatric patients. Third generation cephalosporins were mainly used in all indications, and Watch antibiotics were observed in 70% cases, while Access antibiotics were used in 5-8%. Admission specialty (p=0.037), peripheral catheterization (p<0.001), and urinary catheterization (p=0.005) were significantly associated with AMU. It is evident that there are significant stewardship problems, such as over-prescribing, over-use of Watch antibiotics, and poor documentation. It is important to improve stewardship practices, implement prescribing guidelines, and follow WHO AWaRe recommendations.]]>
