TY - JOUR
T1 - Adaptation of the WHO AWaRe (Access, Watch, Reserve) antibiotic classification to support national antimicrobial stewardship priorities in the UK
T2 - findings from a modified Delphi approach to achieve expert consensus
AU - Bou-Antoun, Sabine
AU - Oettle, Rebecca C.
AU - Leanord, Alistair
AU - Seaton, Ronald Andrew
AU - Cooper, Ben S.
AU - Muller-Pebody, Berit
AU - Conlon-Bingham, Geraldine
AU - Kerr, Frances
AU - Hand, Kieran S.
AU - Sandoe, Jonathan A.T.
AU - Llewelyn, Martin J.
AU - Fleming, Naomi
AU - Brown, Nicholas M.
AU - Reid, Nicholas
AU - Howard, Philip
AU - McKinstry, Sarah Jayne
AU - Malcolm, William
AU - Demirjian, Alicia
AU - Ashiru-Oredope, Diane
N1 - Publisher Copyright:
© Crown copyright 2025.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - Objectives: In 2017, the WHO introduced the AWaRe (Access, Watch and Reserve) classification of antibiotics to support antibiotic stewardship (AMS) at local, national and global levels. We assessed the categorization of each of the antibiotics for systemic use for antimicrobial stewardship and quality improvement practice across primary and secondary care in the UK, proposing a nationally adapted UK-AWaRe classification. Methods: A four-stage modified Delphi survey was conducted to review the AWaRe classifications in light of antibiotic resistance profiles, antibiotic use and stewardship practice in the UK. Recommendations were iteratively discussed and consensus reached on how to adapt the WHO AWaRe list. Implications of the proposed new categorization for possible antibiotic usage targets were assessed using England national antibiotic consumption data as a case study. Results: Sixty-one experts across the four UK nations participated in the modified Delphi process. Consensus was most easily reached, with least between-expert variation, for Access antibiotics. Seventeen antibiotics differed in categorization when comparing proposed adapted UK-AWaRe classification and the 2023 WHO AWaRe classification. Through the focus group discussions, the importance of clear messaging was highlighted for the proposed move of first-generation cephalosporins into the Access category, a step-change from the 2019 England AWaRe classification, where all cephalosporins were in the Watch category. From the case study analysis of national data in England, Access antibiotics accounted for >60% of human antibiotic use between 2018 and 2022, 69.7% when using the WHO 2023 classification and 63.7% with the proposed UK-adapted 2024 classification. Conclusions: An adapted UK-AWaRe list has been suggested through a consensus-reaching process. This will support national AMS and antibiotic usage targets of the UK antimicrobial resistance 2024–29 national action plan.
AB - Objectives: In 2017, the WHO introduced the AWaRe (Access, Watch and Reserve) classification of antibiotics to support antibiotic stewardship (AMS) at local, national and global levels. We assessed the categorization of each of the antibiotics for systemic use for antimicrobial stewardship and quality improvement practice across primary and secondary care in the UK, proposing a nationally adapted UK-AWaRe classification. Methods: A four-stage modified Delphi survey was conducted to review the AWaRe classifications in light of antibiotic resistance profiles, antibiotic use and stewardship practice in the UK. Recommendations were iteratively discussed and consensus reached on how to adapt the WHO AWaRe list. Implications of the proposed new categorization for possible antibiotic usage targets were assessed using England national antibiotic consumption data as a case study. Results: Sixty-one experts across the four UK nations participated in the modified Delphi process. Consensus was most easily reached, with least between-expert variation, for Access antibiotics. Seventeen antibiotics differed in categorization when comparing proposed adapted UK-AWaRe classification and the 2023 WHO AWaRe classification. Through the focus group discussions, the importance of clear messaging was highlighted for the proposed move of first-generation cephalosporins into the Access category, a step-change from the 2019 England AWaRe classification, where all cephalosporins were in the Watch category. From the case study analysis of national data in England, Access antibiotics accounted for >60% of human antibiotic use between 2018 and 2022, 69.7% when using the WHO 2023 classification and 63.7% with the proposed UK-adapted 2024 classification. Conclusions: An adapted UK-AWaRe list has been suggested through a consensus-reaching process. This will support national AMS and antibiotic usage targets of the UK antimicrobial resistance 2024–29 national action plan.
UR - http://www.scopus.com/inward/record.url?scp=85215836681&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/8c667349-51a7-3139-b3b1-6a22131aea08/
U2 - 10.1093/jacamr/dlae218
DO - 10.1093/jacamr/dlae218
M3 - Article
AN - SCOPUS:85215836681
SN - 2632-1823
VL - 7
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 1
M1 - dlae218
ER -
