Urges wider adoption of tools for more appropriate prescribing of antibiotics To combat the growing problem of antimicrobial resistance, all countries should adopt tools to encourage more appropriate use of antibiotics, said the World Health Organization (WHO). Of course, the WHO encouraged the adoption of its own tool, called AWaRe, which is part of the WHO Essential Medicines List. AWaRe was launched in 2017, and it divides antibiotics into three categories (Access, Watch, and Reserve). It is designed to encourage more judicious prescribing of second- and third-line antibiotics and "last resort" antibiotics, while encouraging the use of first-line antibiotics to treat common infections. "[The AWaRe tool] addresses this problem [of antimicrobial resistance] from a clinical perspective," said Hanan Balkhy, MD, WHO's Assistant Director General for Antimicrobial Resistance, on a media call with reporters. "By launching this tool, the World Health Organization aims at narrowing the gap between access and excess." The AWaRe tool classifies 37 antibiotics, 19 of which are in the Access category -- such as amoxicillin. The goal would be to reduce unnecessary use of remaining antibiotics in the Watch category (such as ceftriaxone) and Reserve category (such as colistin), the WHO said. The goal of this initiative is to both increase the global consumption of antibiotics in the Access group to at least 60% by 2030 and reduce use of antibiotics most prone to resistance from the Watch and Reserve groups, WHO officials said. They described the AWaRe tool as "targeted at decision-makers, policy-makers or what's prescribed by medical doctors." Balkhy characterized the initiative as an "advertising campaign" for both healthcare professionals and the public to make them more "aware that there is a system, a methodology, a science behind antibiotic prescriptions." Indeed, the WHO is set to launch a global campaign on June 19 entitled "Adopt AWaRe: Handle antibiotics with care" at a conference on antimicrobial resistance in Noordwijk, The Netherlands. WHO director-general Tedros Adhanom Ghebreyesus, PhD, weighed in on the issue in a statement. "Antimicrobial resistance is one of the most urgent health risks of our time and threatens to undo a century of medical progress," he said. "All countries must strike a balance between ensuring access to life-saving antibiotics and slowing drug resistance by reserving the use of some antibiotics for the hardest-to-treat infections." Currently, the WHO said 19 countries are using the AWaRe tool. But on the call, a reporter pointed out that the U.S. is not one of them, nor does the U.S. monitor antibiotic consumption on a national level. Balkhy responded that while countries are urged to have "one way or another to measure consumption," and are encouraged to use the AWaRe tool, it is not the only method to measure consumption of antibiotics. "The CDC is using other tools for measurement, and there is usage data at hospital levels. Advanced hospitals in developed countries are developing methodologies to calculate [antibiotic] consumption data," she said. Balkhy noted that for doctors in particular, it is "extremely difficult to change behavior and practices," especially when there are many factors involved in the prescribing of antibiotics. "It's not just about the behavior of the physician, but it's also stimulated and influenced by patients, families, the culture, the environment, the country -- all come into play in how the physician prescribes antibiotics," she said. Balkhy said that she hoped the WHO list could be "a legitimate reference for healthcare professionals who would like to understand better ways of prescribing antibiotics." She noted that the tool would provide guidelines and give them a system to prescribe antibiotics based on "a resource such as the WHO." "There's a lot of weight coming from the WHO," Balkhy said. Source
