The WHO AWaRe Antibiotic Book: providing guidance on optimal use and informing policy

Sharland, Mike; Cappello, Bernadette; Ombajo, Loice Achieng; Bazira, Joel; Chitatanga, Ronald; Chuki, Pem; Gandra, Sumanth; Harbarth, Stéphan Juergen; Loeb, Mark; Mendelson, Marc; Moja, Lorenzo; Pulcini, Céline; Tacconelli, Evelina; Zanichelli, Veronica; Zeng, Mei; Huttner, Benedikt

doi:10.1016/s1473-3099(22)00683-1

Cited by 28 publications

(16 citation statements)

References 3 publications

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“…The WHO AWaRe classification 7 was utilized and antibiotic use was expressed as percentage of total hospital antibiotic use (DDD/1000 occupied‐bed days [OBD]) and total primary care antibiotic use (DDDs/1000 inhabitants/day).…”

Section: Methodsmentioning

confidence: 99%

“…Prior to the pandemic, much attention was being focused on stewardship and its role in reducing the burden of AMR. The WHO developed a framework, the AWaRe system (Access, Watch and Reserve), which enabled the grouping of antibiotics into categories to support stewardship 7 . The response to the pandemic required that a significant amount of healthcare resource was mobilized to tackle the global emergency; however, antibiotic stewardship programmes and infection control measures have been rapidly adapted to address the COVID‐19 pandemic and its subsequent sequelae 8 .…”

Section: Introductionmentioning

confidence: 99%

“…The WHO developed a framework, the AWaRe system (Access, Watch and Reserve), which enabled the grouping of antibiotics into categories to support stewardship. 7 The response to the pandemic required that a significant amount of healthcare resource was mobilized to tackle the global emergency; however, antibiotic stewardship programmes and infection control measures have been rapidly adapted to address the COVID-19 pandemic and its subsequent sequelae. 8 Early in the pandemic, the novelty of the virus and the difficulty in differentiating COVID-19 from bacterial pneumonia was observed, which led to some patients without bacterial infections receiving unnecessary antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

Aldeyab

Crowe

Karasneh

et al. 2023

Brit J Clinical Pharma

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AimTo evaluate the impact of the COVID‐19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland.MethodsData were collected on antibiotic use and Gram‐positive and Gram‐negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015‐March 2020) and during (April 2020‐December 2021) the pandemic. Time series intervention analysis methods were utilized.ResultsIn the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied‐bed days (OBD), showing no significant change from pre‐pandemic (P = .7365). During the pandemic, the use of second‐generation cephalosporins, third‐generation cephalosporins, co‐amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin‐susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID‐19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID‐19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community‐onset Pseudomonas aeruginosa cases.ConclusionThis study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID‐19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

Aldeyab

Crowe

Karasneh

et al. 2023

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Confirming the presence of GAS at the point of care allows for prescribing narrow-spectrum antibiotics, such as amoxicillin, with low impact in terms of selective pressure, and possibly at lower doses. 15 However, GAS strains with reduced susceptibility to ß-lactams have been reported and justified surveillance and vigilance. 16 Of note, we did not identify any clinical parameter significantly associated with the presence of GAS in MEF culture.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Group A Streptococcus Rapid Antigen Detection Test on Middle Ear Fluid in Children With Acute Otitis Media With Spontaneous Perforation: A Prospective Multicenter Evaluation

Cohen

Varon

Bidet

et al. 2023

Pediatric Infectious Disease Journal

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“…[7][8][9] In Niger, mass distribution of azithromycin was associated with not only persistence of genetic determinants of macrolide resistance in the gut, but also notable increases in resistance determinants from 4 different antibiotic classes (β-lactams, trimethoprim, metronidazole, and aminoglycosides) 10 that are all in the WHO access list of antimicrobials and are routinely recommended as essential first-or second-choice empirical treatments for commonly encountered pathogens. 11 These findings are alarming given the high global burden of bacterial antimicrobial resistance (AMR) in many low-income settings, with the highest rates of AMR in sub-Saharan Africa. 12 Increased rates of AMR from mass antibiotic distribution may decrease after cessation of such programs.…”

mentioning

confidence: 99%

Azithromycin for Prevention of Mortality in African Children

John,

Namazzi,

Schneider

2024

JAMA

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Mass administration of oral azithromycin is central to the World Health Organization (WHO) campaign to eliminate trachoma. 1 Mass administration of azithromycin could have beneficial effects in young children due to its activity against pathogens causing pneumonia, diarrhea, and malaria, but could also have harmful effects, including generation of antimicrobial resistance. In 2009, a cluster randomized clinical trial showed that mass administration of oral azithromycin was associated with a 49% reduction in mortality in Ethiopian children aged 1 to 9 years. 2 The subsequent Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial in Malawi, Niger, and Tanzania showed that twice-yearly mass distribution of azithromycin to children aged 1 to 59 months reduced mortality by 13.5%, but, among the 3 countries, mortality was reduced significantly only in Niger. In all 3 countries, the greatest benefit was seen in children aged 1 to 5 months. 3 The heterogeneity of results from these studies led to a qualified recommendation from WHO that mass administration of azithromycin could be considered for children aged 1 to 11 months in sub-Saharan African settings with high mortality rates among those younger than 5 years, but that further study was needed before more widespread azithromycin use for reduction of childhood mortality could be recommended. 4 Among the questions raised by the MORDOR trial data were the mechanism of azithromycin efficacy: why it was efficacious only in 1 country, why benefits were seen most in children aged 1 to 5 months, the risks of antimicrobial resistance, and whether azithromycin would be beneficial in areas where children receive seasonal malaria chemoprevention (SMC). To address the latter question, the MORDOR trial group initiated the Community Health With Azithromycin Treatment (CHAT) trial, the results of which are presented in this issue of JAMA. 5 In this rigorous and well-conducted clinical trial, communities in Nouna, Burkina Faso, a region in which SMC with sulfadoxime/pyrimethamine and amodiaquine is given, were randomized to have children 1 to 59 months of age in the community receive either a single dose of azithromycin or placebo twice yearly. The authors found a reduction in mortality that approached statistical significance (18% [95% CI, −2% to 33%]; P = .07) and, in a subgroup analysis, found the greatest reduction in children aged 24 to 59 months. Lower mortality than expected led to the trial being slightly underpowered, but the effect size of mortality reduction (18%) was similar that in the MORDOR trial (14%), in which SMC was not given. With another large study, now in an area with SMC, suggesting reduced mortality after mass azithromycin administration in

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The WHO AWaRe Antibiotic Book: providing guidance on optimal use and informing policy

Cited by 28 publications

References 3 publications

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

The impact of the COVID‐19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland

Diagnostic Accuracy of Group A Streptococcus Rapid Antigen Detection Test on Middle Ear Fluid in Children With Acute Otitis Media With Spontaneous Perforation: A Prospective Multicenter Evaluation

Azithromycin for Prevention of Mortality in African Children

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