From the WHO Bulletin. Bull World Health Organ. 2023 Apr 1; 101(4): 290–296. Abstract and a comment from me below.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10042089/?report=classic
The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance
Veronica Zanichelli, a Michael Sharland, b Bernadette Cappello, a Lorenzo Moja, a Haileyesus Getahun, c Carmem Pessoa-Silva, d Hatim Sati, c Catharina van Weezenbeek, d Hanan Balkhy, e Mariângela Simão, f Sumanth Gandra, g and Benedikt Huttnercorresponding author a
ABSTRACT
Guidance on the appropriate use of antibiotics for common infections is lacking in many settings. The World Health Organization (WHO) has recently released The WHO AWaRe (Access, Watch, Reserve) antibiotic book which complements the WHO Model list of essential medicines and WHO Model list of essential medicines for children. The book gives specific guidance on the empiric use of antibiotics in the model lists with a strong emphasis on the AWaRe framework, which is centred around the risk of antimicrobial resistance development associated with the use of different antibiotics. Recommendations in the book cover 34 common infections in primary and hospital care both for children and adults. The book also includes a section on the use of the last-resort Reserve antibiotics, whose use should be restricted to very selected cases when an infection is confirmed or suspected to be caused by multidrug-resistant pathogens. The book highlights the use of first-line Access antibiotics or no antibiotic care if this is the safest approach for the patient. Here we present the background behind the development of the AWaRe book and the evidence behind its recommendations. We also outline how the book could be used in different settings to help reach the WHO target of increasing the proportion of global consumption of Access antibiotics to at least 60% of total consumption. The guidance in the book will also more broadly contribute to improving universal health coverage.
COMMENT (NPW): It is indeed an indictment of the global evidence ecosystem that 'Guidance on the appropriate use of antibiotics for common infections is lacking in many settings'. This is an issue that applies to all medicines, not just antibiotics. In 2011 WHO stated that ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ World Medicines Report, WHO. However, restricted access to information on antibiotics is potentially catastrophic as a driver of antibiotic resistance, which is already killing over a million people every year and this figure is expected to increase exponentially.
This new publication from WHO is welcome but what is neeeded urgently is for WHO to convene stakeholders to develop and implement a common agenda to improve the availability and use of reliable information on antibiotics and indeed all medicines. A global action plan is needed to deliver universal access to reliable information for prescribers and users of medicines.
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
