Antibiotic 'Access' list updated for the UK
Source: gov.uk (2025-01-29)

UKHSA has published an updated antimicrobial stewardship tool

The UK Health Security Agency (UKHSA) has published an updated antimicrobial stewardship tool (https://www.gov.uk/government/publications/uk-aware-antibiotic-classification) to support healthcare professionals across the UK prescribe the most appropriate antibiotics for patients, while protecting their future effectiveness.

The UK’s tool is based on the World Health Organization’s (WHO) AWaRe (Access, Watch or Reserve) classification system, which was developed to support good antibiotic stewardship at local, national and global levels. This recent review, which applies to all 4 nations in the UK, was conducted in response to the WHO updating its categories in 2023.

Most patients should receive Access antibiotics in the first instance, which offer the most effective treatment while minimising the potential for resistance. However, in a few cases some patients may require Watch or Reserve. Watch antibiotics are first or second choice antibiotics indicated for a limited number of infections, while Reserve are “last resort” or new antibiotics. These are closely monitored and prioritised as targets of stewardship programmes to ensure continued effectiveness.

In UKHSA’s latest review (https://academic.oup.com/jacamr/article/7/1/dlae218/7955613?login=true), with contribution from 60 experts across the 4 UK nations, the English Surveillance Programme for Antimicrobial Utilisation and Resistance oversight group and Department of Health Expert Advisory Group on Antimicrobial Prescribing, Resistance and Healthcare-associated Infection (APRHAI) has provided a UK classification for 90 antibiotics.

The most significant change is that all first-generation cephalosporins are now classed as Access, compared to Watch in 2019. This means that patients with certain allergies, such as penicillin, will have access to a wider range of antibiotics that currently show less potential to develop resistance to bacteria than others. The change aligns with the 2023 WHO AWaRe classification but does not mandate increased use of cephalosporins. All other cephalosporins remain in the Watch or Reserve categories.

In keeping with UKHSA’s review in 2019, amoxicillin/clavulanic acid remains in Watch in the UK, but is classified as Access in the 2023 WHO AWaRe classification. Amoxicillin/clavulanic acid is an important and widely used drug globally. However, in the UK setting specifically, experts judged that its use is more likely to develop resistance in bacteria compared to other antibiotics.

UK-AWaRe classification is an important stewardship tool to help achieve the 20-year UK vision to contain and control antimicrobial resistance. It also supports one of the national targets set in the UK National Action Plan for antimicrobial resistance 2024 to 2029. By 2029, the UK is aiming to achieve 70% of total use of antibiotics from the Access category across the human healthcare system to preserve efficacy. According to the latest assessment in 2023, this was 64.1% for England.

Dr Colin Brown, Deputy Director at UKHSA said:

The AWaRe classification has played an important role in antibiotic stewardship in the UK and continues to do so. This review for the UK will help healthcare professionals choose the best treatment options for their patients, while preserving the effectiveness of antibiotics for future use.

It will also support the development of guidelines for antibiotic prescribing and our UK targets to tackle antibiotic resistance set out in the National Action Plan.

Appropriate use of antibiotics is essential in our fight against resistant bacteria.