Definition

• WHO classification of antibiotics
• Meant to improve stewardship efforts worldwide (particularly in LMICs)
• Varies by country; we will talk about the UK-specific classification

Meaning:

• Definitions according to UKHSA:

  

• Access:

  • To be used in standard therapy
  • Can have a high barrier to resistance
  • e.g. Gentamicin

• Watch:

  • Second-line agents, used up front in selected circumstances or when Access agents fail/aren’t appropriate
  • e.g. Ceftriaxone:
    • 1st line in meningitis
    • 2nd line for SSTI

• Reserve:

  • Cool stuff for ID doctors that isn’t for the riff raff.
  • Indications: Access & Watch ABx considered inappropriate or suboptimal therapy
  • e.g. carbapenems for ESBL

WHO AWARE classification:

Bold = not in UKHSA. Original Excel spreadsheet is below.

Notes:

• Much more extensive than UKHSA
• Excludes anti-TB drugs
• Includes lots of:
  • Beta lactam alternatives (Penicillins, 1G/2G/3G/4G Cephs, Carbapenems, Carumonam)
  • Tetracyclines
  • Aminoglycosides
  • Macrolides
  • Quinolones
  • Sulfonamides (Solo & in combination with Trimethoprim)
• Interesting points:
  • Carbapenems are Watch!
  • Tetracyclines:
    • Most (except for Doxy/Tetracycline) are Watch
    • IV Mino is Reserve (why?)
  • Pristinamycin is Watch but Quinupristin/Dalfopristin is Reserve