The World Health Organization (WHO) has launched a global campaign calling on governments to adopt a tool to limit the spread of antimicrobial resistance, as well as adverse events and costs.
The AWaRe tool has been developed by the WHO Essential Medicines List to curb growing antimicrobial resistance and make antibiotic use safer and more effective. It classifies antibiotics into three groups (antibiotics whose accessibility is essential, antibiotics to be used selectively and reserve antibiotics) and specifies which antibiotics to use for the most common and most serious infections, which should be available at all times in the healthcare system, and which should be used sparingly or kept and used only as a last resort.
The new campaign aims to increase to at least 60% the proportion of global antibiotic consumption in the "antibiotics whose accessibility is essential" group, and to reduce the use of antibiotics most exposed to the risk of resistance in the "antibiotics for selective use" and "reserve antibiotics" groups. The use of "antibiotics whose accessibility is essential" reduces the risk of resistance because they are "narrow-spectrum" antibiotics (targeting a specific micro-organism rather than several). They are also less expensive because they are available in generic formulations.
Antimicrobial resistance is one of the most pressing health risks of our time, threatening to undo a century of medical progress. All countries need to strike a balance between ensuring access to life-saving antibiotics and slowing drug resistance by reserving the use of certain antibiotics for the most difficult-to-treat infections. I urge countries to adopt AWaRe, as it is a valuable and practical tool for achieving this. Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
Antimicrobial resistance is a global threat to health and development that continues to intensify worldwide, as highlighted in a recent report by the United Nations Inter-Agency Task Force on Antimicrobial Resistance. It is estimated that over half of all antibiotics are currently used inappropriately in many countries. They are, for example, administered to combat viruses when they only fight bacterial infections, or they are misused (broad-spectrum antibiotics, for example), which encourages antimicrobial resistance.
One of the most pressing concerns is the spread of resistant gram-negative bacteria, notably Acinetobacter, Escherichia coli and Klebsiella pneumoniae. These bacteria, commonly found in hospitalized patients, cause infections such as pneumonia, bloodstream infections, wound or surgical site infections and meningitis. When antibiotics are no longer effective, more expensive treatment and hospitalization are required, putting a heavy strain on already tight healthcare budgets.
At the same time, many low- and middle-income countries have significant gaps in access to effective and appropriate antibiotics. Childhood deaths from pneumonia (estimated at nearly a million a year worldwide) due to lack of access to antibiotics remain frequent in many parts of the world. And although over a hundred countries have put in place national plans to combat antimicrobial resistance, only around a fifth of these plans are funded and implemented.
In the absence of substantial investment in the development of new antibiotics, improving antibiotic use is one of the key measures needed to curb the emergence and spread of antimicrobial resistance. By classifying antibiotics into three distinct groups and providing advice on their use, AWaRe helps policymakers, prescribers and healthcare workers choose the right antibiotic at the right time, and protect endangered antibiotics.
According to Dr Mariângela Simão, Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals at the WHO, "antimicrobial resistance is an invisible pandemic. We are already seeing signs of a post-antibiotic era, with the emergence of infections that cannot be treated by any class of antibiotics. We need to protect these valuable last-line antibiotics so that we can continue to treat and prevent serious infections."