Bou-Antoun Sabine, Oettle Rebecca C, Leanord Alistair, Seaton Ronald Andrew, Cooper Ben S, Muller-Pebody Berit, Conlon-Bingham Geraldine, Kerr Frances, Hand Kieran S, Sandoe Jonathan A T, Llewelyn Martin J, Fleming Naomi, Brown Nicholas M, Reid Nicholas, Howard Philip, Mckinstry Sarah-Jayne, Malcolm William, Demirjian Alicia, Ashiru-Oredope Diane
Antimicrobial Resistance (AMR) and Healthcare-Associated Infection (HCAI) Division, United Kingdom Health Security Agency (UKHSA), London, UK.
Infection and Immunity, MVLS, University of Glasgow, Glasgow, Scotland, UK.
JAC Antimicrob Resist. 2025 Jan 16;7(1):dlae218. doi: 10.1093/jacamr/dlae218. eCollection 2025 Feb.
In 2017, the WHO introduced the AWaRe (ccess, tch and serve) classification of antibiotics to support antibiotic stewardship (AMS) at local, national and global levels. We assessed the categorization of each of the antibiotics for systemic use for antimicrobial stewardship and quality improvement practice across primary and secondary care in the UK, proposing a nationally adapted UK-AWaRe classification.
A four-stage modified Delphi survey was conducted to review the AWaRe classifications in light of antibiotic resistance profiles, antibiotic use and stewardship practice in the UK. Recommendations were iteratively discussed and consensus reached on how to adapt the WHO AWaRe list. Implications of the proposed new categorization for possible antibiotic usage targets were assessed using England national antibiotic consumption data as a case study.
Sixty-one experts across the four UK nations participated in the modified Delphi process. Consensus was most easily reached, with least between-expert variation, for Access antibiotics. Seventeen antibiotics differed in categorization when comparing proposed adapted UK-AWaRe classification and the 2023 WHO AWaRe classification. Through the focus group discussions, the importance of clear messaging was highlighted for the proposed move of first-generation cephalosporins into the Access category, a step-change from the 2019 England AWaRe classification, where all cephalosporins were in the Watch category. From the case study analysis of national data in England, Access antibiotics accounted for >60% of human antibiotic use between 2018 and 2022, 69.7% when using the WHO 2023 classification and 63.7% with the proposed UK-adapted 2024 classification.
An adapted UK-AWaRe list has been suggested through a consensus-reaching process. This will support national AMS and antibiotic usage targets of the UK antimicrobial resistance 2024-29 national action plan.
2017年，世界卫生组织（WHO）推出了抗生素的AWaRe（可及、谨慎使用和储备）分类法，以在地方、国家和全球层面支持抗生素管理（AMS）。我们评估了英国初级和二级医疗中用于抗菌管理和质量改进实践的每种全身用抗生素的分类，提出了一个在英国适用的英国-AWaRe分类法。
开展了一个四阶段的改良德尔菲调查，根据英国的抗生素耐药性概况、抗生素使用情况和管理实践，对AWaRe分类法进行审查。就如何调整WHO的AWaRe清单进行了反复讨论并达成共识。以英格兰国家抗生素消费数据为案例研究，评估了拟议的新分类法对可能的抗生素使用目标的影响。
来自英国四个国家的61位专家参与了改良德尔菲过程。对于可及类抗生素，最容易达成共识，专家之间的差异最小。将拟议的英国适用的AWaRe分类法与2023年WHO的AWaRe分类法进行比较时，有17种抗生素的分类有所不同。通过焦点小组讨论，强调了清晰传达信息对于将第一代头孢菌素归入可及类的重要性，这与2019年英格兰的AWaRe分类法有很大不同，在2019年的分类法中，所有头孢菌素都属于谨慎使用类。从英格兰国家数据的案例研究分析来看，在2018年至2022年期间，可及类抗生素占人类抗生素使用量的60%以上，采用WHO 2023年分类法时为69.7%，采用拟议的英国适用的2024年分类法时为63.7%。
通过达成共识的过程，提出了一个适用的英国-AWaRe清单。这将支持英国2024-2029年抗菌药物耐药性国家行动计划中的国家AMS和抗生素使用目标。
