Comparison of antibiotics included in national essential medicines lists of 138 countries using the WHO Access, Watch, Reserve (AWaRe) classification: a cross-sectional study

Adekoya, Itunuoluwa; Maraj, Darshanand; Steiner, Liane; Yaphe, Hannah; Moja, Lorenzo; Magrini, Nicola; Cooke, Graham; Loeb, Mark; Persaud, Nav

doi:10.1016/s1473-3099(20)30854-9

Cited by 22 publications

(21 citation statements)

References 24 publications

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“… A and W: Access and Watch (AWaRe classification); SAP: Surgical Antibiotic Prophylaxis; SSIs: Surgical Site Infections; * World Bank Status (Based on [ 59 ]). …”

Section: Resultsmentioning

confidence: 99%

“…The intention was to list the various studies as exemplars going forward. The various African countries were broken down by their World Bank classification, i.e., low-income, low-middle and upper-middle-income countries, building on the recent study of Adekoya et al (2021) for consistency [59]. This is because, as mentioned, there have been concerns with available resources and personnel within hospitals among LMICs to undertake PPS studies, and we wanted to explore this further.…”

Section: Antimicrobial Utilization Patterns In Hospitals Across Africamentioning

confidence: 99%

“…The ‘Access’ group are considered as first- or second-line antibiotics for up to 26 common or severe clinical syndromes, typically with a narrow spectrum and low resistance potential. The ‘Watch’ group have a higher resistance potential and side-effects, with the ‘Reserve’ group only recommended as last resort antibiotics and prioritized for Antimicrobial Stewardship Programs (ASPs) using agreed quality indicators (QIs) ( Figure 1 ) [ 55 , 56 , 57 , 58 , 59 ]. Assessing antimicrobial prescribing against current guidance, and monitoring their use based on the WHO AWaRe list, is increasingly being undertaken across Africa and beyond to improve prescribing given the extent of current prescribing of ‘Watch’ and ‘Reserve’ antibiotics in Africa [ 13 , 15 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ].…”

Section: Introductionmentioning

confidence: 99%

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Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

et al. 2022

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There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

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“… A and W: Access and Watch (AWaRe classification); SAP: Surgical Antibiotic Prophylaxis; SSIs: Surgical Site Infections; * World Bank Status (Based on [ 59 ]). …”

Section: Resultsmentioning

confidence: 99%

Section: Antimicrobial Utilization Patterns In Hospitals Across Africamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

et al. 2022

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“…There was no documented use of Reserve antibiotics based on the 2019 AWaRe classification. From a recent global assessment of national EMLs, those of Barbados and Saint Lucia did not contain Reserve antibiotics, and the Guyana national EML included only one (20). Although these countries have access to antibiotic treatment for priority infections, this lack of Reserve antibiotics is alarming, as countries in the Caribbean are already facing widespread multidrug resistance.…”

Section: Access Watch and Reserve Prescribingmentioning

confidence: 99%

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean

Rocke

Omeiri

Quirós

et al. 2022

Revista Panamericana De Salud Pública

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Objective. To assess antibiotic use in three hospitals in three Caribbean countries based on data from 2013 and 2018 using the World Health Organization Essential Medicines List “Access, Watch, Reserve” (AWaRe) classification Methods. A retrospective observational study, which analyzed the World Health Organization Point Prevalence Survey data from three hospitals in three Caribbean countries, to examine proportional AWaRe group antibiotic use for the top ten inpatient indications. The Access-to-Watch ratio was calculated, and the top three antibiotics prescribed in each hospital were determined. Results. The final data set included 376 prescriptions for the top ten indications in 766 inpatients. The hospital antibiotic use point prevalence for Hospital 1 was 35.6%, Hospital 2 was 48.6%, and Hospital 3 was 47.1%. The Access-to-Watch ratio for the top ten indications was 2.45, 1.36, and 1.72 in the three hospitals. Access group prevalence was 71.0% in Hospital 1, 57.6% in Hospital 2, and 63.2% in Hospital 3. There were no Reserve antibiotics prescribed in any of the institutions. The most common indication for Watch prescription was skin and soft tissue infections in Hospital 1 and pneumonia in Hospital 2 and 3. Conclusions. This study draws urgent attention to evidence of a high proportion of Watch antibiotic prescribing and lack of Reserve group antibiotics in three Caribbean countries. This research provides data that may inform national formulary and antimicrobial stewardship policy-making across the settings analyzed and the wider region.

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“…The widespread use of colistin as an agricultural growth promoter drove the rapid spread of colistin resistant E. coli across one-health settings, including farms, humans and the environment (Y. Shen, Zhou, et al 2018). Colistin is a WHO reserve antibiotic for the treatment of infections caused by multi-drug resistant gram-negative pathogens (Adekoya et al 2021). The widespread presence of colistin resistance in pathogenic and commensal E. coli represents an important threat to the clinical utility of colistin.…”

Section: Introductionmentioning

confidence: 99%

Regulatory fine-tuning and horizontal gene transfer stabilize mobile colistin resistance

Ogunlana

Shaw

Kuar

et al. 2022

Preprint

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Antibiotic resistance tends to carry fitness costs, making it difficult to understand how resistance can be stably maintained in pathogen populations over the long-term. Here, we investigate this problem in the context of mcr-1, a fitness-costly gene that confers resistance to the last-resort antibiotic, colistin. Here we show that regulatory evolution has fine-tuned the expression of mcr-1, allowing E. coli to reduce the cost of mcr-1 while simultaneously increasing colistin resistance. Conjugative plasmids have transferred low cost/high resistance mcr-1 alleles across an incredible diversity of E. coli strains, further stabilizing mcr-1 at the species level. Crucially, regulatory mutations were associated with increased mcr-1 stability in pig farms following a ban on the use of colistin as a growth promoter that decreased colistin consumption by 90%. Our study shows how the rapid evolution and horizontal transmission of resistance genes can combine to stabilize resistance and reduce the efficiency of interventions aimed at reducing AMR by limiting antibiotic consumption.

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Comparison of antibiotics included in national essential medicines lists of 138 countries using the WHO Access, Watch, Reserve (AWaRe) classification: a cross-sectional study

Cited by 22 publications

References 24 publications

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean

Regulatory fine-tuning and horizontal gene transfer stabilize mobile colistin resistance

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