Battling anti-microbial resistance

Poonam Khetrapal | Updated on February 29, 2020

WHO’s AWaRe tool can help safeguard precious drugs

Antimicrobial resistance (AMR) is one of the 21st century’s greatest threats to health. Across the world, AMR kills an estimated 700,000 people each year. By 2050, unless urgent action is taken, it is projected to kill 10 million annually.

AMR occurs when the effectiveness of antimicrobial drugs — including antibiotics — is diminished due to mutations in infectious bacteria. One of the most important causes of AMR, and the superbugs it creates, is the use of high-power antibiotics where less potent drugs would do.

The WHO South-East Asia Region has made steady progress in its efforts to deal with this issue. As per the Global Action Plan on AMR, all 11 of the region’s member-states are implementing a multi-sectoral national action plan to tackle the problem. They have signed on to the Global Antimicrobial Resistance Surveillance System (GLASS), a key initiative that informs AMR-related research and decision-making.

Region-wide, member-states are working across sectors to augment reference laboratories, improve regulatory capacity and enhance antibiotic stewardship. In October, WHO’s Regional Office convened a Technical Advisory Group in New Delhi to identify key accelerators, in line with the region’s flagship priority on the issue.

Standing for Access, Watch, Reserve, the AWaRe tool has already been adopted by several of the region’s member-states. More are set to follow. The tool groups antibiotics into three main categories based on their strength and potential impact on AMR. For example, ‘Access’ antibiotics are first- or second-line treatments for common infections. They should be widely accessible.

Access, Watch, Reserve

Antibiotics in the ‘Watch’ category should be applied only to a limited group of well-defined syndromes. Their use should be closely monitored. ‘Reserve’ antibiotics should be applied as a last resort to treat multi- or extensively-drug resistant bacteria. They are a valuable and non-renewable resource. A fourth category — ‘discouraged antibiotics’ — refers primarily to irrational antibiotic combinations that may negatively impact AMR and patient safety.

The AwaRe tool allows policy-makers to effectively monitor antibiotic consumption. This is crucial to ensuring antibiotics are used rationally. By better understanding the absolute and relative consumption of different types of antibiotics, policymakers can identify overconsumption and set targets to reduce the problem. Changes in how antibiotics are prescribed and consumed can be monitored in real time, allowing authorities to make appropriate interventions.

Aid to policy-makers

Second, the tool and its index help policy-makers align their Essential Medicines List (EML) with the WHO Model EML — the gold standard. At present, many countries have EMLs with a disproportionate volume of antibiotics of the same class, which are too often accessible at all levels of care. This encourages the overuse of ‘Watch’ and ‘Reserve’ category antibiotics. (‘Access’ antibiotics should comprise at least 60 per cent of those consumed.) By adopting the tool and applying it to their national EML, the region’s member-states can better balance and optimise their antibiotic use.

Finally, the tool aids policy-makers in updating or establishing national treatment guidelines. By synchronising treatment guidelines with AWaRe categories, health authorities will help ensure that the appropriate category of antibiotic is used for any given infection. This is key to securing the efficacy of ‘Watch’ and ‘Reserve’ antibiotics, which should only be used for a limited number of syndromes and circumstances. Precision is everything.

There is not a moment to lose. AMR is a global threat. And it is making basic infections difficult to treat and surgeries risky. It is sending us back to a pre-antibiotic era.

Though the SEA Region has made commendable efforts in addressing the problem, more are needed. WHO’s AWaRe tool provides a simple yet powerful means for countries to improve antibiotic treatment, increase access and reduce antimicrobial resistance.


The writer is Regional Director, WHO South East Asia. Views are personal.

Published on February 29, 2020

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