Increasing the use of the WHO AWaRe system in antibiotic surveillance and stewardship programmes in low- and middle-income countries

作者：Zikria Saleem, Samia Sheikh, Brian Godman, Abdul Haseeb, Shairyar Afzal, Muhammad Usman Qamar, Mohammad Tarique Imam, Safa S. Almarzoky Abuhussain, Mike Sharland · 发表于：JAC-Antimicrobial Resistance · 年份：2025 · DOI：10.1093/jacamr/dlaf031 · 被引用次数：49 · 研究领域：Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria、Pharmaceutical and Antibiotic Environmental Impacts

Introduction: Antimicrobial resistance (AMR) presents a major global health threat, driven in part by the inappropriate use of antibiotics including in low- and middle-income countries (LMICs). Improving the quality of antibiotic use is a key rationale for the development of the WHO's AWaRe (Access, Watch and Reserve) system. There is a need to review the uptake of the AWaRe system since its launch to guide future practice. Methods: A literature search was conducted between 2017, the launch of AWaRe, and 2024. Inclusion criteria were studies that reported on antibiotic use in LMICs using the AWaRe system. Results: Eighty-five studies were included in the review, of which 56.4% focused on antibiotic use trends, with 28.2% reporting on prescribing patterns; 51.7% of the studies included inpatients. Only 14.1% of studies reported meeting the 2024 United Nations General Assembly (UNGA) AMR recommended target of at least 70% of human antibiotic use being Access antibiotics, with a concerning trend of overuse of Watch antibiotics (68.2% of studies). Dispensing practices revealed significant dispensing of antibiotics without prescriptions especially in Pakistan and Bangladesh. Watch antibiotics were more available but also more expensive than Access antibiotics. Conclusions: Encouragingly, many LMICs are now reporting antibiotic use via the AWaRe system, including in antimicrobial stewardship programmes (ASPs). Wide variation exists in the proportion of AWaRe antibiotics used across...