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Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe.

Budd, E; Cramp, E; Sharland, M; Hand, K; Howard, P; Wilson, P; Wilcox, M; Muller-Pebody, B; Hopkins, S (2019) Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe. J Antimicrob Chemother, 74 (11). pp. 3384-3389. ISSN 1460-2091 https://doi.org/10.1093/jac/dkz321
SGUL Authors: Sharland, Michael Roy

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Abstract

OBJECTIVES: Appropriate use of and access to antimicrobials are key priorities of global strategies to combat antimicrobial resistance (AMR). The WHO recently classified key antibiotics into three categories (AWaRe) to improve access (Access), monitor important antibiotics (Watch) and preserve effectiveness of 'last resort' antibiotics (Reserve). This classification was assessed for antibiotic stewardship and quality improvement in English hospitals. METHODS: Using an expert elicitation exercise, antibiotics used in England but not included in the WHO AWaRe index were added to an appropriate category following a workshop consensus exercise with national experts. The methodology was tested using national antibiotic prescribing data and presented by primary and secondary care. RESULTS: In 2016, 46/108 antibiotics included within the WHO AWaRe index were routinely used in England and an additional 25 antibiotics also commonly used in England were not included in the WHO AWaRe index. WHO AWaRe-excluded and -included antibiotics were reviewed and reclassified according to the England-adapted AWaRE index with the justification by experts for each addition or alteration. Applying the England-adapted AWaRe index, Access antibiotics accounted for the majority (60.9%) of prescribing, followed by Watch (37.9%) and Reserve (0.8%); 0.4% of antibiotics remained unclassified. There was unexplained 2-fold variation in prescribing between hospitals within each AWaRe category, highlighting the potential for quality improvement. CONCLUSIONS: We have adapted the WHO AWaRe index to create a specific index for England. The AWaRe index provides high-level understanding of antibiotic prescribing. Subsequent to this process the England AWaRe index is now embedded into national antibiotic stewardship policy and incentivized quality improvement schemes.

Item Type: Article
Additional Information: © Crown copyright 2019. This article contains public sector information licensed under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/ open-government-licence/version/3/). These terms are compatible with the Creative Commons Attribution License 4.0 and the Open Data Commons Attribution License, both of which license copyright and database rights. This means that when the Information is adapted and licensed under either of those licences, you automatically satisfy the conditions of the OGL when you comply with the other licence. The OGLv3.0 is Open Definition compliant.
Keywords: 1115 Pharmacology And Pharmaceutical Sciences, 0605 Microbiology, 1108 Medical Microbiology, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: J Antimicrob Chemother
ISSN: 1460-2091
Language: eng
Dates:
DateEvent
November 2019Published
30 July 2019Published Online
26 June 2019Accepted
Publisher License: Open Government Licence 3.0
PubMed ID: 31361000
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111103
Publisher's version: https://doi.org/10.1093/jac/dkz321

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