RT Journal Article SR Electronic T1 Analysis of antibiotic use patterns in Danish hospitals 2015–2021 using an adapted version of the who aware classification JF BMJ Open Quality JO BMJ Open Qual FD British Medical Journal Publishing Group SP e002098 DO 10.1136/bmjoq-2022-002098 VO 11 IS 4 A1 Jacob Anhøj A1 Jonas Boel A1 Birthe Riis Olesen A1 Helle Boelsmand Bak A1 Anne-Marie Blok Hellesøe A1 Kim Thomsen A1 Jenny Dahl Knudsen YR 2022 UL http://bmjopenquality.bmj.com/content/11/4/e002098.abstract AB Background AWaRe is a tool to categorise and guide antibiotic use. Antibiotics are classified in three groups: Access, Watch and Reserve. The Access group contains first choice antibiotics for 25 of the most common infections. Antibiotics in the Watch and Reserve groups should be restricted to cases that cannot be effectively treated with drugs from the Access group.Objectives The primary aim of this study was to evaluate and adapt the WHO 2019 AWaRe classification for use with antibiotic usage data in Danish hospitals. The secondary aim was to study the usefulness of the abxaware; software package for visualisation and analysis of temporal trends in antibiotic use patterns.Methods We obtained data on purchases of antibiotics in Danish hospitals from January 2015 to July 2021. Sixty-seven unique drugs had been purchased. To better correspond with Danish guidelines, we moved two drugs one AWaRe level upwards. To help aggregate antibiotics according to AWaRe and visualise use patterns, we developed an R package, abxaware.Results After adding two drugs that were not included in the original AWaRe classification nearly all antibiotics (>99%) used in Danish hospitals were covered. The abxaware software package for R is a useful tool to help aggregate, visualise and analyse antibiotic use patterns.Conclusions With minor modifications, we adapted the AWaRe classification to cover most antibiotics used in Danish hospitals and to reflect Danish treatment guidelines. The abxaware package is a useful tool to aggregate and plot antibiotic usage data according to the AWaRe classification and to test for non-random variation in the percentage use of Access antibiotics.