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Progress towards WHO AWaRe targets: an analysis of data from high-income countries, 2013-2018

  • Simmons, B
  • Ariyoshi, K
  • Ohmagari, N
  • Pulcini, C
  • Huttner, B
  • Gandra, S
  • Satta, G
  • Moja, L
  • Sharland, M
  • Magrini, N
  • Miraldo, M
  • Cooke, G
Publication Date
Mar 29, 2021
Spiral - Imperial College Digital Repository


Objectives: To compare antibiotic consumption in eight high-income countries in reference to the 2019 World Health Organization (WHO) AWaRe classification (Access, Watch, and Reserve) and the 60% Access use consumption target. Methods: Sales data (IQVIA) were analysed for systemic antibiotics from 2013-2018 for France, Italy, Japan, Germany, Spain, Switzerland, United Kingdom, and United States. Antibiotics were classified as Access, Watch, Reserve, and Not Recommended according to the 2019 WHO AWaRe categories. The primary objectives were to calculate: i) antibiotic sales per capita in standard units (SU/capita) overall and by AWaRe category; and ii) the Access percentage, defined as total SU of Access group antibiotics by the total antibiotic SU. Findings: In 2018, there was variability among countries in sales per capita, ranging from 7.4 (Switzerland) to 20.0 (France) SU/capita; median Access sales was 10.9 SU/capita (range 3.5-15.0). Per capita sales moderately declined over time (p<0.01). Median Access percentage was 68% (range 22-77%); Access proportion increased in most countries between 2013 and 2018. Five countries studied exceeded the 60% target; two narrowly missed it (≥55% in Italy and Germany). Access use in Japan was low (22%), driven by a relatively high use of oral cephalosporins and macrolides. Conclusion: Most countries studied are achieving the 60% Access target, however per capita consumption differed significantly. The AWaRe classification provides a framework to inform national antibiotic policies and the 60% indicator provides a target for optimised use. The target should be complemented by absolute measures and adapted to more ambitious values in specific settings.

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