Abstract
ObjectiveTo compare antibiotic sales in eight high-income countries using the 2019 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification and the target of 60% consumption of Access category antibiotics.MethodsWe analysed data from a commercial database of sales of systemic antibiotics in France, Germany, Italy, Japan, Spain, Switzerland, United Kingdom of Great Britain and Northern Ireland, and United States of America over the years 2013–2018. We classified antibiotics according to the 2019 AWaRe categories: Access, Watch, Reserve and Not Recommended. We measured antibiotic sales per capita in standard units (SU) per capita and calculated Access group sales as a percentage of total antibiotic sales.FindingsIn 2018, per capita antibiotic sales ranged from 7.4 SU (Switzerland) to 20.0 SU (France); median sales of Access group antibiotics were 10.9 SU per capita (range: 3.5–15.0). Per capita sales declined moderately over 2013–2018. The median percentage of Access group antibiotics was 68% (range: 22–77 %); the Access group proportion increased in most countries between 2013 and 2018. Five countries exceeded the 60% target; two countries narrowly missed it (> 55% in Germany and Italy). Sales of Access antibiotics in Japan were low (22%), driven by relatively high sales of oral cephalosporins and macrolides.ConclusionWe have identified changes to prescribing that could allow countries to achieve the WHO target. The 60% Access group target provides a framework to inform national antibiotic policies and could be complemented by absolute measures and more ambitious values in specific settings.
Highlights
Antimicrobial resistance is a major threat to global health, endangering the ability to prevent and manage many common infectious diseases.[1,2] High rates of use and misuse of antibiotics have contributed to selection pressures on drug-resistant strains of common pathogens, leading to a shift towards more expensive and broad-spectrum antibiotics.[3]
The Access, Watch and Reserve (AWaRe) categorization is a tool introduced by the World Health Organization (WHO) to encourage antibiotic stewardship and to combat antimicrobial resistance.[5]
The categorization was first introduced in the 2017 WHO essential medicines list, in which key antibiotics were classified into three categories – Access, Watch and Reserve – according to their therapeutic and resistance profile.[6]
Summary
Antimicrobial resistance is a major threat to global health, endangering the ability to prevent and manage many common infectious diseases.[1,2] High rates of use and misuse of antibiotics have contributed to selection pressures on drug-resistant strains of common pathogens, leading to a shift towards more expensive and broad-spectrum antibiotics.[3]. The Access, Watch and Reserve (AWaRe) categorization is a tool introduced by the World Health Organization (WHO) to encourage antibiotic stewardship and to combat antimicrobial resistance.[5] The categorization was first introduced in the 2017 WHO essential medicines list, in which key antibiotics were classified into three categories – Access, Watch and Reserve – according to their therapeutic and resistance profile.[6] Access group antibiotics are defined as priority treatments recommended as first- and second-choice options for common infections that should be available and affordable in all countries. Recognizing the role of the AWaRe as a policy tool, the WHO essential medicines list expert committee updated the classification in 2019 to categorize additional antibiotics into the three groups and to add a new category: Not Recommended.[7,8] To reduce the use of Watch and Reserve group antibiotics, the WHO Thirteenth General Programme of Work 2019–2023 has adopted the following target to be reached by 2023: at least 60% of national antibiotic consumption should be from the Access group.[9,10] Adoption of this target at the national level should help to inform and galvanize action and can be used to monitor progress, allowing for comparison of antibiotic stewardship efforts
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