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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.
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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. The recommendation is that greater than 60% of antibiotics used within a country come from the "access"
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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.
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Antibiotics in the watch group are typically broad-spectrum antibiotics with a greater risk of resistance. They are generally only recommended if other options are not possible. They should be used carefully to save their effectiveness for those cases in which "access" antibiotics are not
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and are typically recommended as first- and second-line treatments of infections. They are generally inexpensive and safe. They should be readily available when needed, and are highlighted in green. Access group antibiotics include
506:"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"
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and their importance to medicine. It does not reflect effectiveness or strength. It is accompanied by a book that outlines which and how to use antibiotics in 34 common
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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).
61:. The classification as of 2021 covers 258 items. Challenges in its implementation include lack of awareness, little political will, and few resources.
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The selection and use of essential medicines 2023: web annex A: World Health
Organization model list of essential medicines: 23rd list (2023)
447:"World Health Organization AWaRe framework for antibiotic stewardship: Where are we now and where do we need to go? An expert viewpoint"
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The reserve group are generally last line options and used for infections not treatable by other antibiotics, i.e.
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appropriate. Costs are also generally greater, and they are highlighted in yellow. Included in this category are
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391:"The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance"
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is reserve while the by mouth formulation is watch. About 10% of this group is available by mouth.
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An occasionally included fourth group defines antibiotics whose use is not recommended.
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38:. The classification is based, in part, on the risk of developing
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Antimicrobial
Stewardship & Healthcare Epidemiology: ASHE
178:. They are highlighted in red. Include in this category are
271:. Geneva: World Health Organization. 2023. pp. 17–18.
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The WHO AWaRe (Access, Watch, Reserve) antibiotic book
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The WHO AWaRe (Access, Watch, Reserve) antibiotic book
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Antibiotics in the access group have a lower risk of
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57:(WHO) and launched in 2017. It is an aspect of the
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445:Mudenda S, Daka V, Matafwali SK (2023).
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579:. Geneva: World Health Organization.
59:WHO Model List of Essential Medicines
164:. About 40% are available by mouth.
129:. Nearly 60% can be taken by mouth.
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331:from the original on 13 August 2023
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176:multi-drug-resistant organisms
22:World Health Organization Logo
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235:"2021 AWaRe classification"
95:amoxicillin/clavulanic acid
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589:. WHO/MHP/HPS/EML/2023.02.
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36:appropriate antibiotic use
30:is a method to categorize
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510:Frontiers in Microbiology
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55:World Health Organization
358:"WHO Antibiotics Portal"
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28:WHO AWaRe Classification
362:aware.essentialmeds.org
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407:10.2471/BLT.22.288614
180:ceftazidime/avibactam
82:antibiotic resistance
40:antibiotic resistance
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609:. 9 December 2022.
327:. 9 December 2022.
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188:polymyxin B
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32:antibiotics
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210:References
196:fosfomycin
162:vancomycin
148:, several
99:ampicillin
44:infections
617:16 August
473:2732-494X
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249:16 August
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107:cefalexin
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482:10173285
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329:Archived
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146:Cefixime
87:amikacin
169:Reserve
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134:Watch
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469:ISSN
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369:2023
337:2023
273:ISBN
251:2023
125:and
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