Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries
Authors: Yingfen Hsia, Brian R Lee, Ann Versporten, Yonghong Yang, Julia Bielicki, Charlotte Jackson, Jason Newland, Herman Goossens, Nicola Magrini, Mike Sharland, Adam Irwin, Akhila Akula, Alasdair Bamford, Amanda Chang, Andre da Silva, Andrew Whitelaw, Angela Dramowski, Anil Kumar Vasudevan, Anita Sharma, Antonio Justicia, Ashok Chikkappa, Barbara Slowinska-Jarzabek, Bianca Rippberger, Changan Zhao, Chiara Tersigni, Chinglan Cheng, Christian Harkensee, Chuamei Jing, Chunmei Zhu, Chunyan Li, Claudia Tagliabue, Cristina Epalza, Daglish Jacqueline, Daiyin Tian, Dasaratha Jinka, Despoina Gkentzi, Dhanya Dharmapalan, Dona Benadof, Eleni Papadimitriou, Elias Iosifidis, Emmanuel Roilides, Erbu Yarci, Ewa Majda-Stanisławska, Ewelina Gowin, Faye Chappell, Federico Martinon Torres, Francis Collett-White, Gang Liu, Gen Lu, George Syrogiannopoulos, Georgia Pitsava, Gerardo Alvarez-Uria, Hana Renk, Hana Mahmood, Harri Saxen, Heather Finlayson, Helen Green, Helena Rabie, Hemasree Kandraju, Hong Zhang, Ita Okokon, Jack Cross, Jethro Herberg, Jianping Li, Jiaosheng Zhang, Jikui Deng, Jing Liu, Jing Qian, Jinhong Yang, Joanna Sicińska, Johannes Hübner, Kahoru Fukuoka, Kaihu Yao, Kaman Cheung, Karla Ojeda, Katerina Kaffe, Katharina Kreitmeyer, Katja Doerholt, Keith Grimwood, Kirsty Ledoare, Konstantinos Vazouras, Kunling Shen, Lanfang Tang, Lehai Zhang, Li Lin, Liat Ashkenazi-Hoffnung, Lijuan Wu, Lijun Wang, Lilian Teston, Luisa Galli, Lynne Speirs, Maria Tsolia, Markus Hufnagel, Markus Knuf, Marzia Duse, Mingjie Ding, Mojca Rozic, Mueller Premru, Natasha O'Connell, Nikolaus Rieber, Nikos Spyridis, Onkaraiah Tunga, Pablo Rojo Conejo, Paddy McMaster, Pagakrong Lumbiganon, Paola Pansa, Patrizia D'Argenio, Paul Moriarty, Petra Nikolic, Ping Wang, Pongsatorn Paopongsawan, Qing Cao, Qiulian Deng, Ramanan Laxminarayan, Ravishankar Kanithi, Rodolfo Jimenez, Sancheng Cao, Sanjeev Singh, Sarah Rees, Saroey Praveen, Satu Kekomaki, Scott Hackett, Shai Ashkenazi, Si Min Chang, Simon Drysdale, Sonia Koning, Sreeram Subramanian, Srinivas Murki, Stefania Vergnano, Sumanth Gandra, Susanna Esposito, Suvaporn Anugulruengkitt, Thanyawee Puthanakit, Uta Behrends, Vana Papaevangelous, Victoria Jian, Wei Li, Wei Zhao, Wei Wang, Wenshuang Zhang, Xiaoping Mu, Xiaoyie Dong, Xiyuan Jiang, Xu Chen, Yi Wang, Yuejie Zheng, Yuho Horikoshi, Aaron Aboderin, Adebola Olayinka, Amela Dedeic-Ljubovic, Ann McCorry, Anthony Enimil, Antje Neubert, antonio solano, Antonio Pignatari, Aruna Poojary, Baktygul Kambaralieva, Bernadette McCullagh, Biljana Carevi, Bruno Van Herendael, Cairine Gormley, Camila Carvajal, Carlos Ramírez, David Fitzgerald, Deana Sabuda, Deborah Konopnicki, Denada Lacej, Denis Pierard, Edgar Rios, Emily Marshall, Eric Firre, Erika van Elzakker, Erjona Shaqiri, Feras Darwish Elhajji, Gerard Gawrys, Goran Markovic, Hiroyuki Kunsihima, Hui Hiong Chen, Inese Sviestina, Irina Pristas, Iris Hoxha, Irma Korinteli, Ivana Mareković, Jafar Soltani, Jaime Labarca, Jameela AlSalman, Jasminka Horvatic, Juliet Ampomah Frimpong, Karaman Pagava, Kasahara Kei, Keiji Okinaka, Kenneth Iregbu, Lilit Ghazaryan, Lul Raka, Mallory Gessner-Wharton, Mamoon Aldeyab, Mandelin Cooper, Marcelo del Castillo, Martin Hojman, Melissa Hudson, Mohamed Alshehri, Moi Lin Ling, Nickie Greer, Oyinlola Oduyebo, Patricia Buijtels, PEDRO TEROL BARRERO, Peter Zarb, PEtra Schelstraete, Princewill Ifeanyi Philip Nwajiobi-Princewill, Priya Khanna, Rodolfo Quiros, Sanja Simovic, Sarah Thompson, Si Min Chan, Sigita Burokiene, Simon Drysdale, Svetlana Rachina, Vytautas Usonis, Wanda Cornistein, Xavier Holemans, Yoshiaki Gu, Adam Brothers, Adam Hersh, Alfred Fernandez, Alison Tribble, Amanda Hurst, Andrea Green, Benjamin Hammer, Betty P Lee, Brenik Kuzmic, Craig Shapiro, Craig Boge, David Haslam, David Berman, Fouzia Naeem, George Johnson, Hayden Schwenk, Hillary Orr, Holly Maples, Jared Olsen, Jeffrey Gerber, Jennifer Girotto, Jennifer Zweiner, Jennifer Goldman, Jessica Gillon, Jessica Tansmore, John Manaloor, Joshua Courter, Kanokporn Mongkolrattanothai, Karisma Patel, Kathryn Merkel, Katie Namtu, Kelly Flett, Kelly Lee, Kristen Nichols, Kristin Klein, Lori Handy, Luis Castagnini, Marc Mazade, Margaret Heger, Marisol Fernandez, Michael Chang, Michelle Crawford, Miranda Nelson, Nicholas Bennett, Preeti Jaggi, Rana Hamdy, Ritu Banerjee, Rosemary Olivero, Sameer Patel, Sandra Arnold, Sara Ogrin, Sarah Jones, Sarah Parker, Sarah Kubes, Saul Hymes, Scott Weissman, Shannon Chan, Sheryl Henderson, Talene Metjian
Journal: The Lancet Global Health (2019)

Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications.Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries.There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index.GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS.