The UK’s tool is based on the World Health Organisation’s (WHO) AWaRe (Access, Watch or Reserve) classification system, which was developed to support good antibiotic stewardship at local, national and global levels. The review was conducted in response to the WHO updating its categories in 2023.
Most patients should receive ‘Access’ antibiotics in the first instance, which offer the most effective treatment while minimising the potential for resistance. However, in a few cases, some patients may require ‘Watch’ or ‘Reserve’. ‘Watch’ antibiotics are first or second choice antibiotics indicated for a limited number of infections, while ‘Reserve’ are ‘last resort’ or new antibiotics. These are closely monitored and prioritised as targets of stewardship programmes to ensure continued effectiveness.
In UKHSA’s latest review, with contributions from 60 experts, the English Surveillance Programme for Antimicrobial Utilisation and Resistance oversight group and Department of Health Expert Advisory Group on Antimicrobial Prescribing, Resistance and Healthcare-associated Infection (APRHAI) has provided a UK classification for 90 antibiotics.
The most significant change is that all first-generation cephalosporins are now classed as Access, compared to Watch in 2019. This means that patients with certain allergies, such as penicillin, will have access to a wider range of antibiotics that currently show less potential to develop resistance to bacteria than others. The government has said the change aligns with the 2023 WHO AWaRe classification but does not mandate increased use of cephalosporins.
In keeping with UKHSA’s review in 2019, amoxicillin/clavulanic acid remains in Watch in the UK but is classified as Access in the 2023 WHO AWaRe classification. In the UK setting specifically, experts judged that its use is more likely to develop resistance in bacteria compared to other antibiotics.
Colin Brown, deputy director at UKHSA, said, “The AWaRe classification has played an important role in antibiotic stewardship in the UK and continues to do so. This review for the UK will help healthcare professionals choose the best treatment options for their patients, while preserving the effectiveness of antibiotics for future use.
“Appropriate use of antibiotics is essential in our fight against resistant bacteria.”