Antimicrobial stewardship plays a vital role in the fight against antimicrobial resistance, a pressing global issue. Its significance in controlling and managing antimicrobial resistance is widely recognized and acknowledged by experts and healthcare professionals alike. The objective of this study was to acquire a comprehensive comprehension of the utilization of antimicrobial drugs within a medicine and surgery unit at a tertiary hospital in India. To achieve this, a qualitative case study methodology was employed. The study employed a qualitative case study design, focusing on a specific prospective audit and feedback process within the hospital. Data collection involved reviewing archival data and conducting expert interviews by approaching antimicrobial stewardship and surveillance. The collected data were analyzed using the WHO's AWaRe classification framework, which facilitated a structured analysis of antimicrobial usage. It also considered the perspectives of various stakeholders in developing guidelines for responsible antibiotic use. The research focused on the utilization of reserve antimicrobial drugs based on the AWaRe classification. The findings indicated a decrease in the utilization of these drugs over the study period, suggesting effective efforts to reduce unnecessary usage. The study contributes to promoting responsible antibiotic use and addressing antimicrobial resistance in Indian tertiary hospitals.