The WHO essential medicines list AWaRe book: from a list to a quality improvement system

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

doi:10.1016/j.cmi.2022.08.009

Cited by 64 publications

(76 citation statements)

References 12 publications

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“…Another concern was the frequent use of third generation cephalosporins in this study, which are typically ‘Watch’ antibiotics under the WHO AWaRe classification [ 57 , 58 ]. Unnecessary prescription of ‘Watch’ and ‘Reserve’ antibiotics should be reduced as part of an effort to reduce resistance rates within a country [ 59 , 60 , 61 ]. This is particularly important in Pakistan given the high rates of AMR in the country, generally high rates of prescription of ‘Watch’ and ‘Reserve’ antibiotics within hospitals and the urgent need to reduce AMR as part of the agreed National Action Plan [ 52 , 56 , 62 , 63 , 64 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

et al. 2023

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Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

et al. 2023

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“…We are seeing antimicrobial stewardship programs (ASPs) being successfully introduced among hospitals across LMICs to improve appropriate antibiotic prescribing despite initial concerns, and these can serve as exemplars for Pakistan in the future [ 44 , 45 , 80 , 81 , 82 , 83 ]. We will be following this up in future studies now that the AWaRe book has been published, providing guidance for a range of infections, combined with suggested prescribing and quality indicators [ 60 , 84 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there has been considerable prescribing of ‘Watch’ and ‘Reserve’ antibiotics from the WHO AWaRe list. This is important as the antibiotics from the ‘Watch’ and ‘Reserve’ list have a greater resistance potential than those from the ‘Access’ list [ 41 , 60 ]. Their prescribing in Pakistan needs to be appreciably reduced to achieve a suggested target of 60% ‘access’ antibiotics being prescribed [ 37 , 38 , 39 , 60 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is important as the antibiotics from the ‘Watch’ and ‘Reserve’ list have a greater resistance potential than those from the ‘Access’ list [ 41 , 60 ]. Their prescribing in Pakistan needs to be appreciably reduced to achieve a suggested target of 60% ‘access’ antibiotics being prescribed [ 37 , 38 , 39 , 60 ]. However, we are unaware of any studies that have been conducted among neonates and children in Pakistan to investigate the current utilization patterns in this group.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

et al. 2023

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There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being ‘Watch’ antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.

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“…The “watch” group of antibiotics have a higher resistance potential as well as a greater side-effect profile, with the “reserve” group recommended only as a last resort and typically prioritized for any ASPs alongside agreed quality indicators [ 88 , 89 ]. As a result, the WHO is developing quality indicators to reduce the utilization of “Watch” and “Reserve” antibiotics in favor of greater utilization of “Access” antibiotics [ 147 ]. In addition, antimicrobials and antihistamines dispensed were classified by their ATC classification [ 148 ].…”

Section: Methodsmentioning

confidence: 99%

Knowledge, Attitude and Practices of Self-Medication Including Antibiotics among Health Care Professionals during the COVID-19 Pandemic in Pakistan: Findings and Implications

et al. 2023

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Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns for patients’ safety and a rise in antimicrobial resistance (AMR). Healthcare workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence-based. However, this is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a range of public sector hospitals in the Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude regarding, medicines they purchased. However, there are concerns that high rates of purchasing antibiotics, especially “Watch” antibiotics, for self-medication may enhance AMR. This needs addressing.

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The WHO essential medicines list AWaRe book: from a list to a quality improvement system

Cited by 64 publications

References 12 publications

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

Knowledge, Attitude and Practices of Self-Medication Including Antibiotics among Health Care Professionals during the COVID-19 Pandemic in Pakistan: Findings and Implications

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