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Background and Importance In 2017, the WHO classified antibiotics into Access, Watch, and Reserve groups to promote global, resistance-aware antibiotic use!Aim and Objectives Antibiotic stewardship (ABS) programs aim to promote rational antibacterial use and to reduce the prescription of Watch and Reserve antibiotics, as defined by the WHO AWaRe classification. According to the German ABS S3 guideline, ABS ward rounds represent one of three core strategies for improving prescribing behaviour. This study aimed to evaluate the impact of ABS ward rounds on antibiotic prescribing patterns.Material and Methods A single-centre interventional study was conducted at a German university hospital, where weekly ABS ward rounds were implemented across eleven wards (including normal and intensive care units) starting in November 2023. Changes in antibiotic prescribing practices were assessed using point prevalence analyses (PPA) performed on days 1 and 2 in March and September 2023 (baseline, prior to ABS implementation) and on day 3 in March 2024 (post-intervention). Antibiotics were categorised as Access, Watch, or Reserve according to the WHO AWaRe classification. Prescription frequencies in the baseline phase (n = 1,163 therapies, 849 patients) and the intervention phase (n = 629 therapies, 466 patients) were compared. The Access-to-Watch ratio was calculated by dividing the number of prescribed Access antibiotics by the number of prescribed Watch antibiotics. Changes in this ratio between phases were quantified through analysis.Results Prescriptions for Watch antibiotics decreased from 43.1% to 36.1%, while Reserve antibiotics showed a slight increase from 2.8% to 3.3%. Prescriptions for Access antibiotics increased from 43.2% to 48.5%. Analysis revealed a balanced Access-to-Watch ratio of 1.0 during the baseline phase, which was below the WHO target value (≥ 1.5). During the intervention phase, the ratio increased significantly to 1.34, approaching the recommended prescribing practice (Access proportion ≥ 70%). Additionally, the proportion of intravenous administrations declined slightly from 68.8% to 67.2% over the study period.Conclusion and Relevance Overall, the results demonstrate the beneficial effect of ABS ward rounds on antibiotic prescribing behaviour. Both the Access-to-Watch ratio and the proportion of oral antibiotic therapies increased significantly, indicating an improvement in antibiotic selection and a shift towards more rational prescribing practices as a result of the intervention.Conflict of Interest No conflict of interest