WHO AWaRe

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The WHO AWaRe Classification is a method to categorize antibiotics into three groups in an effort to improve appropriate antibiotic use. [1] [2] The classification is based, in part, on the risk of developing antibiotic resistance and their importance to medicine. [1] [3] It does not reflect effectiveness or strength. [4] It is accompanied by a book that outlines which and how to use antibiotics in 34 common infections. [5]

Contents

The three groups are "access", meaning use can be unrestricted, "watch", meaning care should be taken, and "reserve" meaning use should be saved for cases in which other options are not possible. [3] The recommendation is that greater than 60% of antibiotics used within a country come from the "access" group. [6]

The classification was developed by the World Health Organization (WHO) and launched in 2017. [1] It is an aspect of the WHO Model List of Essential Medicines. [3] The classification as of 2021 covers 258 items. [1] Challenges in its implementation include lack of awareness, little political will, and few resources. [6]

The WHO AWaRe Classification categorized antibiotics into three groups to improve appropriate antibiotic use, based on resistance risk and medical importance. "Access" antibiotics could be used freely, "watch" antibiotics required caution, and "reserve" antibiotics were for last-resort cases. Developed by the WHO, this classification aimed to ensure proper antibiotic utilization. A recent study conducted by Abdelsalam Elshenawy et al. at an English NHS Foundation Trust examined antibiotic prescribing trends during the COVID-19 pandemic, guided by the AWaRe classification. It shed light on shifting prescription patterns, highlighting the importance of antimicrobial stewardship. There was a marked rise in the consumption of antibiotics in the Watch category, while usage of certain antibiotics remained consistently high. These findings emphasized the imperative for vigilant antimicrobial stewardship to address evolving prescribing trends and combat resistance, thereby safeguarding patient health. [7]

Classification

Access

Antibiotics in the access group have a lower risk of antibiotic resistance and are typically recommended as first- and second-line treatments of infections. [6] [8] They are generally inexpensive and safe. [3] They should be readily available when needed, and are highlighted in green. [3] [8] Access group antibiotics include amikacin, amoxicillin, amoxicillin/clavulanic acid, ampicillin, benzylpenicillin, cefalexin, chloramphenicol, clindamycin, doxycycline, Metronidazole and nitrofurantoin. [5] Nearly 60% can be taken by mouth. [4]

Watch

Antibiotics in the watch group are typically broad-spectrum antibiotics with a greater risk of resistance. [6] They are generally only recommended if other options are not possible. [3] They should be used carefully to save their effectiveness for those cases in which "access" antibiotics are not appropriate. [8] Costs are also generally greater, and they are highlighted in yellow. [3] Included in this category are azithromycin, Cefixime, several cephalosporins, ciprofloxacin, clarithromycin, and vancomycin. [5] About 40% are available by mouth. [4]

Reserve

The reserve group are generally last line options and used for infections not treatable by other antibiotics, i.e. multi-drug-resistant organisms. [3] [8] They are highlighted in red. [3] Include in this category are ceftazidime/avibactam, colistin, polymyxin B (by mouth and by injection), and linezolid. [1] [5] The intravenous formulation of fosfomycin is reserve while the by mouth formulation is watch. [1] About 10% of this group is available by mouth. [4]

An occasionally included fourth group defines antibiotics whose use is not recommended. [3]

Related Research Articles

<span class="mw-page-title-main">Antibiotic</span> Antimicrobial substance active against bacteria

An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the ones which cause the common cold or influenza; drugs which inhibit growth of viruses are termed antiviral drugs or antivirals rather than antibiotics. They are also not effective against fungi; drugs which inhibit growth of fungi are called antifungal drugs.

<span class="mw-page-title-main">Ampicillin</span> Antibiotic

Ampicillin is an antibiotic belonging to the aminopenicillin class of the penicillin family. The drug is used to prevent and treat a number of bacterial infections, such as respiratory tract infections, urinary tract infections, meningitis, salmonellosis, and endocarditis. It may also be used to prevent group B streptococcal infection in newborns. It is used by mouth, by injection into a muscle, or intravenously.

<span class="mw-page-title-main">Antimicrobial resistance</span> Resistance of microbes to drugs directed against them

Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance where the drugs are no longer effective. Fungi evolve antifungal resistance, viruses evolve antiviral resistance, protozoa evolve antiprotozoal resistance, and bacteria evolve antibiotic resistance. Together all of these come under the umbrella of antimicrobial resistance. Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR) and are sometimes referred to as superbugs. Although antimicrobial resistance is a naturally occurring process, it is often the result of improper usage of the drugs and management of the infections.

<span class="mw-page-title-main">Amoxicillin</span> Beta-lactam antibiotic

Amoxicillin is an antibiotic medication belonging to the aminopenicillin class of the penicillin family. The drug is used to treat bacterial infections such as middle ear infection, strep throat, pneumonia, skin infections, odontogenic infections, and urinary tract infections. It is taken by mouth, or less commonly by injection.

<span class="mw-page-title-main">Ciprofloxacin</span> Fluoroquinolone antibiotic

Ciprofloxacin is a fluoroquinolone antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra-abdominal infections, certain types of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For some infections it is used in addition to other antibiotics. It can be taken by mouth, as eye drops, as ear drops, or intravenously.

<span class="mw-page-title-main">Clindamycin</span> Antibiotic

Clindamycin is a lincosamide antibiotic medication used for the treatment of a number of bacterial infections, including osteomyelitis (bone) or joint infections, pelvic inflammatory disease, strep throat, pneumonia, acute otitis media, and endocarditis. It can also be used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus (MRSA). In combination with quinine, it can be used to treat malaria. It is available by mouth, by injection into a vein, and as a cream or a gel to be applied to the skin or in the vagina.

<span class="mw-page-title-main">Azithromycin</span> Antibiotic

Azithromycin, sold under the brand names Zithromax and Azasite, is an antibiotic medication used for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, and certain other intestinal infections. Along with other medications, it may also be used for malaria. It is administered by mouth, into a vein, or into the eye.

<span class="mw-page-title-main">Amoxicillin/clavulanic acid</span> Combination antibiotic medication

Amoxicillin/clavulanic acid, also known as co-amoxiclav or amox-clav, sold under the brand name Augmentin, among others, is an antibiotic medication used for the treatment of a number of bacterial infections. It is a combination consisting of amoxicillin, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor. It is specifically used for otitis media, streptococcal pharyngitis, pneumonia, cellulitis, urinary tract infections, and animal bites. It is taken by mouth or by injection into a vein.

<span class="mw-page-title-main">Tigecycline</span> Chemical compound

Tigecycline, sold under the brand name Tygacil, is a tetracycline antibiotic medication for a number of bacterial infections. It is a glycylcycline class drug that is administered intravenously. It was developed in response to the growing rate of antibiotic resistant bacteria such as Staphylococcus aureus, Acinetobacter baumannii, and E. coli. As a tetracycline derivative antibiotic, its structural modifications has expanded its therapeutic activity to include Gram-positive and Gram-negative organisms, including those of multi-drug resistance.

<span class="mw-page-title-main">Cefotaxime</span> Chemical compound

Cefotaxime is an antibiotic used to treat a number of bacterial infections in human, other animals and plant tissue culture. Specifically in humans it is used to treat joint infections, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, sepsis, gonorrhea, and cellulitis. It is given either by injection into a vein or muscle.

<span class="mw-page-title-main">Fosfomycin</span> Chemical compound

Fosfomycin, sold under the brand name Monurol among others, is an antibiotic primarily used to treat lower urinary tract infections. It is not indicated for kidney infections. Occasionally it is used for prostate infections. It is generally taken by mouth.

<span class="mw-page-title-main">Antibiotic misuse</span>

Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse or overuse of antibiotics, with potentially serious effects on health. It is a contributing factor to the development of antibiotic resistance, including the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria can develop resistance to multiple antibiotics and cause life-threatening infections.

<span class="mw-page-title-main">Antibiotic use in livestock</span> Use of antibiotics for any purpose in the husbandry of livestock

Antibiotic use in livestock is the use of antibiotics for any purpose in the husbandry of livestock, which includes treatment when ill (therapeutic), treatment of a group of animals when at least one is diagnosed with clinical infection (metaphylaxis), and preventative treatment (prophylaxis). Antibiotics are an important tool to treat animal as well as human disease, safeguard animal health and welfare, and support food safety. However, used irresponsibly, this may lead to antibiotic resistance which may impact human, animal and environmental health.

<span class="mw-page-title-main">Ceftolozane/tazobactam</span> Antibiotic

Ceftolozane/tazobactam, sold under the brand name Zerbaxa, is a fixed-dose combination antibiotic medication used for the treatment of complicated urinary tract infections and complicated intra-abdominal infections in adults. Ceftolozane is a cephalosporin antibiotic, developed for the treatment of infections with gram-negative bacteria that are resistant to conventional antibiotics. It was studied for urinary tract infections, intra-abdominal infections and ventilator-associated bacterial pneumonia.

Antimicrobial stewardship (AMS) refers to coordinated efforts to promote the optimal use of antimicrobial agents, including drug choice, dosing, route, and duration of administration.

Antimicrobial resistance (AMR) directly kills about 1,600 people each year in Australia. This is a currently serious threat to both humans and animals in the country. Antimicrobial resistance occurs when a microorganism evolves and gains the ability to become more resistant or completely resistant to the medicine that was previously used to treat it. Drug-resistant bacteria are increasingly difficult to treat, requiring replacement or higher-dose drugs that may be more expensive or more toxic. Resistance can develop through one of the three mechanisms: natural resistant ability in some types of microorganisms, a mutation in genes or receiving the resistance from another species. Antibodies appear naturally due to random mutations, or more often after gradual accumulation over time, and because of abuse of antibiotics. Multidrug-resistance, or MDR, are the microorganisms that are resistant to many types of antimicrobials. "Superbugs" is the term also used for multidrug-resistant microbes, or totally drug-resistant (TDR).

The Society of Infectious Diseases Pharmacists (SIDP) is a non-profit organization comprising pharmacists and other allied health professionals specializing in infectious diseases and antimicrobial stewardship. According to the Board of Pharmaceutical Specialties, clinical pharmacists specializing in infectious diseases are trained in microbiology and pharmacology to develop, implement, and monitor drug regimens. These regimens incorporate the pharmacodynamics and pharmacokinetics of antimicrobials for patients.

Alison Helen Holmes is a British infectious diseases specialist, who is a professor at Imperial College London and the University of Liverpool. Holmes serves as Director of the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance and Consultant at Hammersmith Hospital. Holmes is on the Executive Committee of the International Society of Infectious Diseases, and she serves on a variety of World Health Organization (WHO) expert groups related to antimicrobial use, Antimicrobial Resistance (AMR), infection prevention and sepsis. Her research considers how to mitigate antimicrobial resistance.

References

  1. 1 2 3 4 5 6 "2021 AWaRe classification". www.who.int. Archived from the original on 3 August 2023. Retrieved 16 August 2023.
  2. ↑ "2.3.5. WHO model lists of essential medicines". WHO Expert Committee on Biological Standardization: seventy-sixth report. Geneva: World Health Organization. 2023. pp. 17–18. ISBN   978-92-4-007448-4. Archived from the original on 2023-11-19. Retrieved 2023-11-17.
  3. 1 2 3 4 5 6 7 8 9 10 The WHO AWaRe (Access, Watch, Reserve) antibiotic book. 9 December 2022. Archived from the original on 13 August 2023. Retrieved 16 August 2023.
  4. 1 2 3 4 "WHO Antibiotics Portal". aware.essentialmeds.org. Retrieved 20 November 2023.
  5. 1 2 3 4 Zanichelli V, Sharland M, Cappello B, Moja L, Getahun H, Pessoa-Silva C, Sati H, van Weezenbeek C, Balkhy H, Simão M, Gandra S, Huttner B (1 April 2023). "The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance". Bulletin of the World Health Organization. 101 (4): 290–296. doi:10.2471/BLT.22.288614. ISSN   0042-9686. PMC   10042089 .
  6. 1 2 3 4 Mudenda S, Daka V, Matafwali SK (2023). "World Health Organization AWaRe framework for antibiotic stewardship: Where are we now and where do we need to go? An expert viewpoint". Antimicrobial Stewardship & Healthcare Epidemiology: ASHE. 3 (1): e84. doi: 10.1017/ash.2023.164 . ISSN   2732-494X. PMC   10173285 . PMID   37179758.
  7. ↑ Elshenawy A (11 December 2023). "WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance – a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic". Frontiers in Microbiology. 14. doi: 10.3389/fmicb.2023.1298858 . hdl: 2299/27284 . PMC   10749484 . PMID   38146447.
  8. 1 2 3 4 World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl: 10665/371090 . WHO/MHP/HPS/EML/2023.02.
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