WHO’S AWARE CLASSIFICATION AS A TOOL OF ANTI-MICROBIAL STEWARDSHIP PROGRAM: A TEACHING HOSPITAL-BASED STUDY
DOI:
https://doi.org/10.22159/ajpcr.2024v17i9.51656Keywords:
AWaRe (Access, Watch and Reserve),, Antimicrobial Resistance (AMR),, Antimicrobial Stewardship Program (ASP),, Antimicrobial Agents (AMA’s)Abstract
Objectives: The aim of the study was to evaluate the antimicrobial utilization pattern and compare it with the World Health Organization’s (WHO’s) access, watch, and reserve (AWaRe) framework for the effective implementation of anti-microbial stewardship program (ASP) for tackling antimicrobial resistance (AMR).
Methods: This was a prospective, observational study conducted by the Department of Pharmacology in association with the Department of Orthopedics, Sher-I-Kashmir Institute of Medical Sciences. Data pertaining to all 208 patients was obtained from the wards of Medical College and Hospital, Bemina, Srinagar, India, for 6 months.
Results: The total number of patients in our study was 208, among them 74 patients received anti-microbial agents (AMAs) from the WHO’s access category whereas 134 were prescribed AMAs from the watch category. The percentage of AWaRe AMAs usage in comparison to the WHO criteria was 35.5% for the access list (WHO optimal value ≥60%), whereas it was 64.4% for the watch list (WHO optimal value ≤40%).
Conclusion: The government of India has no doubt taken a few steps to address this issue but a proactive approach is the need of the hour to minimize AMR saving precious lives and reduce global economic burden, further prescribing doctors should undergo periodic training to update their knowledge. Standard guidelines as developed by AIIMS and WHO should be followed across all the health facilities in India.
Downloads
References
Institute of Medicine (US) Forum on Emerging Infections. The resistance phenomenon in microbes and infectious disease vectors. In: Knobler SL, Lemon SM, Najafi M, Burroughs T, editors. Implications for Human Health and Strategies for Containment: Workshop Summary. Washington, DC: National Academies Press (US); 2003. PMID: 22649806
O’Neill J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Resistance. London: HM Government and Wellcome Trust; 2016. Available from: https:// amr-review.org/sites/default/files/160518_final%/20paper/with%20 cover.pdf [Last accessed on 2024 Jan 12].
Hsia Y, Sharland M, Jackson C, Wong IC, Magrini N, Bielicki JA. Consumption of oral antibiotic formulations for young children according to the WHO Access, watch, reserve (AWaRe) antibiotic groups: An analysis of sales data from 70 middle-income and high-income countries. Lancet Infect Dis. 2019 Jan;19(1):67-75. doi: 10.1016/S1473-3099(18)30547-4, PMID: 30522834
Gandra S, Kotwani A. Need to improve availability of “access” group antibiotics and reduce the use of “watch” group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance. J Pharm Policy Pract. 2019 Jul 17;12:20. doi: 10.1186/s40545-019-0182-1, PMID: 31346472, PMCID: PMC6636108
Hand K. Antibiotic stewardship. Clin Med (Lond). 2013 Oct;13(5):499-503. doi: 10.7861/clinmedicine.13-5-499, PMID: 24115710, PMCID: PMC4953804
Essential Medicines and Health Products Information Portal, a WHO Resource. Available from: https://www.apps.who.int/medicinedocs/en [Last accessed on 24 Apr 2024].
Antimicrobial Resistance (AMR) is Invisible. I am Not. Available from: https://www.who.int/campaigns/world-amr-awareness-week/2024/ amr-is-invisible-i-am-notworld/health/organization [Last accessed on 2023 Sep 03].
World Health Organization. The Rational Use of Drugs. Report of the Conference of Experts. Geneva: World Health Organization; 1985. Available from: https://www.apps.who.int/medicinedocs/en/m/abstract/ Js17054e [Last accessed on 2023 Oct 06].
Holloway K, Dijk VL. Rational Use of Medicines. World Medicines Situation Report. Report No. WHO/EMP/MIE/2011.2.2. World Health Organization; 2011. Available from: https://www.who.int/medicines/ areas/policy/world medicines_situation/wms ch14_wrational.pdf [Last accessed on 2023 Oct 09].
Phadke AR. The quality of prescribing in an Indian district. Natl Med J India. 1996 Mar-Apr;9(2):60-5. PMID: 8857039
Kuruvilla A, George K, Rajaratnam A, John KR. Prescription patterns and cost analysis of drugs in a base hospital in south India. Natl Med J India. 1994 Jul-Aug;7(4):167-8. PMID: 7950948
WHO. More Countries Committing to Tackling Antimicrobial Resistance. World Health Organ. (WHO); 2021. Available from: https:// www.who.int/news/item/11-11-2021-more-countries-committing-to-tackling-antimicrobial-resistance [Last accessed on 2023 Dec 11].
Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543. doi: 10.1002/14651858.CD003543.pub3. Update in: Cochrane Database Syst Rev. 2017 Feb 9;2:CD003543. doi: 10.1002/14651858. CD003543.pub4, PMID: 23633313
Gerding DN. The search for good antimicrobial stewardship. Jt Comm J Qual Improv. 2001 Aug;27(8):403-4. doi: 10.1016/s1070- 3241(01)27034-5, PMID: 11480201
World Health Organization. Global Action Plan on Antimicrobial Resistance. WHO: Antimicrobial Resistance; 2015. Available from: https://www.who.int/antimicrobial-resistance/global-action-plan/en [Last accessed on 2024 Jan 12].
WHO. WHO Access, Watch, Reserve (AWaRe) Antibiotic Book. Classification of Antibiotics for Evaluation and Monitoring of Use; 2021. Available from: https://apps.who.int/iris/rest/bitstreams/1374989/ retrieve [Last accessed on 2024 Apr 01].
(AGISAR) WAGoISoAR. Critically Important Antimicrobials for Human Medicine. Available from: https://www.who.int/foodsafety/ publications/antimicrobials-fifth/en/5th/revision/2016 [Last accessed on 2024 Apr 08].
Nogrady B. The fight against antimicrobial resistance. Nature. 2023 Dec;624(7991):S30-2. doi: 10.1038/d41586-023-03912-8. PMID: 38092932
Ministry of Health and Family Welfare, Government of India. New Delhi. National Health Policy, 2017; 2017a. p. 1-28. Available from: https://cdsco.nic.in/writereaddata/national-health-policy.pdf [Last accessed on 2024 Apr 08].
Ranjalkar J, Chandy SJ. India’s national action Plan for antimicrobial resistance-an overview of the context, status, and way ahead. J Family Med Prim Care. 2019 Jun;8(6):1828-34. doi: 10.4103/jfmpc. jfmpc_275_19, PMID: 31334140, PMCID: PMC6618210
Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014 Jan 9;14:13. doi: 10.1186/1471-2334-14-13, PMID: 24405683, PMCID: PMC3897982
Published
How to Cite
Issue
Section
Copyright (c) 2024 majid farooq bhat
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.