Antimicrobial resistance (AMR) poses a significant threat to
global health and development, contributing to over five million deaths
annually. Urgent global action, utilizing a One Health approach, is essential
to preserve the efficacy of our medicines. One of the key health targets of the
2030 Sustainable Development Goals is ensuring access to safe, effective, and
affordable medicines for all. Careful use of antibiotics and other
antimicrobials is crucial to maintaining their effectiveness.
The misuse and overuse of antibiotics are major drivers of
the global rise in AMR, undermining the effectiveness of these vital medicines.
This could potentially return us to a pre-antibiotic era, where routine
infections could be fatal. The World Health Organization (WHO) is addressing
this issue through the Global Action Plan on AMR, which aims to enhance the
surveillance of antimicrobial resistance and reduce inappropriate antibiotic
use.
The AWaRe antibiotic book, an adjunct to WHO’s Essential
Medicines List (EML), offers concise, evidence-based guidance for treating over
30 common clinical infections in both children and adults, across primary
health care and hospital settings. Since 1977, the EML has been a strategic
component of WHO’s efforts to improve medicine use. The latest EML, published
in 2021, includes 39 antibiotics out of 479 medicines, highlighting their
critical role in healthcare.
Given the urgent threat of AMR and the lifesaving role of
antibiotics, WHO developed practical guidance on their use. The AWaRe system
categorizes antibiotics into three groups – Access, Watch, and Reserve – based
on their clinical importance and the risk of promoting resistance. The AWaRe
antibiotic book provides clear recommendations on the choice, formulation,
dose, and duration of essential antibiotics for hospital and primary health
care settings, including guidance on when not to use antibiotics.
There is a pressing need to develop and implement globally
accepted indicators, building on the AWaRe system, to promote appropriate
antibiotic use and reduce misuse. Challenges remain, such as how data should
inform local policies and changing long-standing patterns of medicine use,
especially in low- and middle-income countries.
The 2022 AWaRe book represents a significant step towards
better antibiotic use, stronger AMR policies, and improved clinical care.
The AWaRe antibiotic book