Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Background Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. Methods 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. Findings Of the 23 572 patients included from 56 countries, 18305 were children (77.7%) and 5267 were neonates (22.3%). Access antibiotic use in children ranged from 7.8% (China) to 61.2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77.3%) and lowest in Finland (23.0%). In neonates, Access antibiotic use was highest in Singapore (100.0%) and lowest in China (24.2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. Interpretation There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

Authors
Hsia Y.F.1 , Lee B.R.2 , Versporten A.3 , Yang Y.H.4, 5 , Bielicki J.1, 6 , Jackson C.1 , Newland J.7 , Goossens H.3 , Magrini N.8 , Sharland M.1 , Teston L.9 , Cheung K.10 , Koning S.11 , Grimwood K.12 , Cross J.12 , Da Silva A.13, 14 , Benadof D.15 , Zhang W.S.16 , Zhao W.17 , Liu G.18 , Shen K.L.18 , Yao K.H.18 , Zheng Y.J.19 , Deng J.K.19 , Zhang J.S.19 , Wang Y. 20 , Jiang X.Y.20 , Tian D.Y.21 , Jing C.M.21 , Wang L.J.22 , Cao S.C.22 , Wu L.J.23 , Chen X.23 , Ding M.J.24 , Zhang L.24 , Lin L.25 , Yang J.H.25 , Cao Q.26 , Wang W.26 , Li J.P.27 , Tang L.F.27 , Liu J.28 , Wang P.28 , Qian J.29 , Zhu C.M.29 , Lu G.30 , Deng Q.L.30 , Mu X.P.31 , Zhao C.A.31 , Dong X.Y.32 , Zhang H.32 , Li C.Y.33 , Li W. 33 , Saxen H.34 , Kekomaki S.34 , Hufnagel M.35, 113 , Rippberger B.35 , Knuf M.36 , Nikolic P.36 , Hubner J.37 , Kreitmeyer K.37 , Behrends U.38 , Rieber N.38 , Renk H.39 , Spyridis N.40 , Tsolia M.40 , Papaevangelous V.41 , Gkentzi D.42 , Syrogiannopoulos G.43 , Kaffe K.43 , Roilides E.44, 115 , Pitsava G.44 , Papadimitriou E.44 , Iosifidis E.44, 115 , Gandra S.45 , Laxminarayan R.45 , Alvarez-Uria G.46 , Jinka D.46 , Murki S.47 , Kandraju H.47 , Singh S. 48 , Vasudevan A.K.48 , Kanithi R.49 , Akula A.49 , Chikkappa A.50 , Tunga O.50 , Subramanian S.51 , Sharma A.52 , Dharmapalan D.53 , Ashkenazi-Hoffnung L.54 , Ashkenazi S.54 , Esposito S.55 , Tagliabue C.56 , Tersigni C.57 , Galli L.57 , D'Argenio P.58 , Pansa P.59 , Duse M.59 , Horikoshi Y.60 , Fukuoka K.60 , Jimenez R.61 , Ojeda K.61 , Okokon I.62 , Mahmood H.63 , Gowin E.64 , Slowinska-Jarzabek B.64 , Majda-Stanislawska E.65 , Sicinska J.65 , Chan S.M.66 , Chang A.66 , Rozic M.67 , Premru M.67 , Finlayson H.68, 145 , Whitelaw A.68 , Rabie H.68 , Dramowski A.68 , O'Connell N.69 , Epalza C.70 , Rojo-Conejo P.70 , Torres F.M.71 , Justicia A.71 , Jian V.72 , Cheng C.L.72 , Lumbiganon P.73 , Paopongsawan P.73 , Puthanakit T.74 , Anugulruengkitt S.74 , Yarci E.75 , Doerholt K.76 , Vazouras K.76 , Bamford A.77 , Irwin A.77 , Drysdale S.B.78 , Collett-White F.78 , Harkensee C.79 , McMaster P.80 , Green H.81 , Rees S.81 , Ledoare K.82 , Chappell F.82 , Jacqueline D.83 , Hackett S.83 , Vergnano S.84 , Praveen S.85 , Herberg J.85 , Speirs L.86 , Moriarty P.86 , Lacej D.87 , Hoxha I.88 , Cornistein W.89, 90 , Quiros R.91 , Hojman M.92 , Del Castillo M.93 , Ghazaryan L.94 , AlSalman J.95 , Konopnicki D.96 , Pierard D.97 , Holemans X.98 , Schelstraete P.99 , Firre E.100 , Van Herendael B.101 , Dedeic-Ljubovic A.102 , Pignatari A.103 , Sabuda D.104 , Carvajal C.105 , Alvaro R.105 , Labarca J.105 , Solano A.106 , Ramirez C.107 , Marekovic I.108 , Horvatic J.108 , Pristas I.109 , Marshall E.110 , Pagava K.111 , Korinteli I.111 , Neubert A.112 , Enimil A.114 , Frimpong J.A.114 , Soltani J.116 , Fitzgerald D.117 , Kasahara K.118 , Gu Y.119 , Okinaka K.120 , Kunishima H.121 , Elhajji F.D.122 , Alshehri M.123 , Raka L.124, 125 , Kambaralieva B.126 , Sviestina I.127, 128 , Burokiene S.129 , Usonis V.129 , Shaqiri E.130 , Zarb P.131 , Markovic G.132 , Simovic S.133 , Nwajiobi-Princewil P.134 , Iregbu K.135 , Aboderin A.136 , Oduyebo O.137 , Olayinka A.138 , McCorry A.139 , McCullagh B.140 , Gormley C.141 , Rachina S. 142 , Carevic B.143 , Chen H.H.66 , Ling M.L.144 , Barrero P.T.146 , Buijtels P.147 , Van Elzakker E.148 , Thompson S.149 , Cooper M.150 , Rios E.151 , Hudson M.152 , Greer N.153 , Gessner-Wharton M.154 , Gawrys G.155
Journal
LANCET GLOBAL HEALTH
Publisher
ELSEVIER SCI LTD
Number of issue
7
Language
English
Status
Published
DOI
10.1016/S2214-109X(19)30071-3
Volume
7
Year
2019
Organizations
  • 1 St Georges Univ London, Paediat Infect Dis Res Grp, Inst Infect & Immun, London, England
  • 2 Childrens Mercy Kansas City, Kansas City, MO USA
  • 3 Univ Antwerp, Lab Med Microbiol, Vaccine & Infect Dis Inst VAXINFECTIO, Fac Med & Hlth Sci, Antwerp, Belgium
  • 4 Capital Med Univ, Lab Microbiol & Immunol, Beijing Childrens Hosp, Beijing, Peoples R China
  • 5 Shenzhen Childrens Hosp, Dept Internal Med, Shenzhen, Peoples R China
  • 6 Univ Basel, Paediat Pharmacol & Paediat Infect Dis, Childrens Hosp, Basel, Switzerland
  • 7 Washington Univ, Dept Pediat, St Louis Childrens Hosp, St Louis, MO 63130 USA
  • 8 WHO, Dept Essential Med & Hlth Prod, Geneva, Switzerland
  • 9 Eurekian Gen Hosp, Buenos Aires, DF, Argentina
  • 10 Monash Childrens Hosp, Melbourne, Vic, Australia
  • 11 Box Hill Hosp Eastern Hlth, Melbourne, Vic, Australia
  • 12 Gold Coast Univ Hosp, Southport, Qld, Australia
  • 13 Prontobaby Childrens Hosp, Rio De Janeiro, Brazil
  • 14 Hosp Domingos Lourenco, Rio De Janeiro, Brazil
  • 15 Roberto Rio Childrens Hosp, Santiago, Chile
  • 16 Tianjin Childrens Hosp, Tianjin, Peoples R China
  • 17 Shandong Univ, Jinan, Shandong, Peoples R China
  • 18 Capital Med Univ, Beijing Childrens Hosp, Beijing, Peoples R China
  • 19 Shenzhen Childrens Hosp, Shenzhen, Peoples R China
  • 20 Fudan Univ, Pediat Hosp, Shanghai, Peoples R China
  • 21 Chongqing Childrens Hosp, Chongqing, Peoples R China
  • 22 Xian Childrens Hosp, Xian, Shaanxi, Peoples R China
  • 23 Shenzhen Baoan Women & Childrens Hosp, Shenzhen, Peoples R China
  • 24 Jinan Childrens Hosp, Jinan, Shandong, Peoples R China
  • 25 Wenzhou Med Univ, Yuying Childrens Hosp, Wenzhou, Peoples R China
  • 26 Shanghai Jiao Tong Univ, Shanghai Childrens Med Ctr, Shanghai, Peoples R China
  • 27 Zhejiang Univ, Sch Med, Childrens Hosp, Hangzhou, Zhejiang, Peoples R China
  • 28 Capital Med Univ, Beijing Obstet & Gynaecol Hosp, Beijing, Peoples R China
  • 29 Capital Inst Paediat, Beijing, Peoples R China
  • 30 Guangzhou Women & Childrens Med Ctr, Zhujiang, Peoples R China
  • 31 Guangdong Prov Women & Childrens Hlth Care Hosp, Shenzhen, Peoples R China
  • 32 Shanghai Childrens Hosp, Shanghai, Peoples R China
  • 33 Jilin Univ, Hosp 1, Changchun, Jilin, Peoples R China
  • 34 Univ Helsinki, Childrens Hosp, Helsinki, Finland
  • 35 Univ Freiburg, Univ Med Ctr, Med Fac, Freiburg, Germany
  • 36 Childrens Hosp Wiesbaden, Wiesbaden, Germany
  • 37 Ludwig Maximilians Univ Munchen, Munich, Germany
  • 38 Tech Univ Hosp Munich, Munich, Germany
  • 39 Univ Childrens Hosp Tubingen, Tubingen, Germany
  • 40 P & A Kyrialcou Childrens Hosp Athens, Athens, Greece
  • 41 Univ Gen Hosp Attikon, Athens, Greece
  • 42 Univ Hosp Patras, Patras, Greece
  • 43 Univ Thessaly, Larisa, Greece
  • 44 Hippokrateion Hosp, Thessaloniki, Greece
  • 45 Ctr Dis Dynam Econ & Policy, New Delhi, India
  • 46 Rural Dev Trust Hosp, Bathalapalli, Andhra Pradesh, India
  • 47 Fernandez Hosp, Hyderabad, India
  • 48 Amrita Inst Med Sci, Kochi, Kerala, India
  • 49 Sowmya Childrens Hosp, Hyderabad, India
  • 50 Rural Dev Trust Hosp, Kalyanadurgam, India
  • 51 Paramitha Childrens Hosp, Hyderabad, India
  • 52 Fortis Hosp, Mohali, India
  • 53 Dr Yewale Multispecialty Hosp Children, Navi Numbai, India
  • 54 Schneider Childrens Med Ctr, Petah Tiqwa, Israel
  • 55 Univ Perugia, Perugia, Italy
  • 56 Univ Milan, Osped Maggiore Policlin, Fdn IRCCS Cagranda, Milan, Italy
  • 57 Anna Meyer Childrens Univ Hosp, Florence, Italy
  • 58 Bambino Gesu Pediat Hosp, Rome, Italy
  • 59 Univ Roma La Sapienza, Rome, Italy
  • 60 Tokyo Metropolitan Childrens Med Ctr, Tokyo, Japan
  • 61 Hosp Infantil Mexico Dr Federico Gomez, Mexico City, DF, Mexico
  • 62 Univ Calabar Teaching Hosp, Calabar, Nigeria
  • 63 Children Hosp PIMS, Islamabad, Pakistan
  • 64 St Joseph Childrens Hosp, Poznan, Poland
  • 65 Med Univ Lodz, Dept Children Infect Dis, Lodz, Poland
  • 66 Natl Univ Singapore Hosp, Singapore, Singapore
  • 67 Univ Med Ctr Ljubljana, Dept Infect Dis, Ljubljana, Slovenia
  • 68 Tygerberg Acad Hosp, Cape Town, South Africa
  • 69 Khayelitsha Hosp, Cape Town, South Africa
  • 70 Hosp 12 Octubre, Madrid, Spain
  • 71 Hosp Clin Univ Santiago de Compostela, Santiago De Compostela, Spain
  • 72 Natl Cheng Kung Univ, Tainan, Taiwan
  • 73 Khon Kaen Univ, Khon Kaen, Thailand
  • 74 Chulalongkorn Univ, Dept Pediat, Bangkok, Thailand
  • 75 Zekai Tahir Burak Matern Teaching Hosp, Ankara, Turkey
  • 76 St Georges Univ London, London, England
  • 77 Great Ormond St Hosp Sick Children, London, England
  • 78 Oxford Univ Hosp NHS Fdn Trust, Oxford, England
  • 79 Univ Hosp North Tees, Hardwick, England
  • 80 Pennine Acute Hosp NHS Trust, Manchester, England
  • 81 Southampton Childrens Hosp, Southampton, Hants, England
  • 82 Evelina London Childrens Hosp, Oxford, England
  • 83 Heartlands Hosp, Birmingham, W Midlands, England
  • 84 Bristol Royal Children Hosp, Bristol, Avon, England
  • 85 St Marys Hosp, London, England
  • 86 Royal Belfast Hosp Sick Children, Belfast, Antrim, North Ireland
  • 87 Univ Hosp Ctr Mother Theresa, Tirana, Albania
  • 88 Univ Med Tirana, Dept Pharm, Tirana, Albania
  • 89 Hosp Cosme Argerich, Buenos Aires, DF, Argentina
  • 90 Inst FLENI, Buenos Aires, DF, Argentina
  • 91 Hosp Univ Austral, Buenos Aires, DF, Argentina
  • 92 Hosp Bernardino Rivadavia, Clin Ios Virreyes, Buenos Aires, DF, Argentina
  • 93 FLENI, Buenos Aires, DF, Argentina
  • 94 Sci Ctr Drug & Med Technol Expertise MoH, Yerevan, Armenia
  • 95 Salmaniya Med Complex, Manama, Bahrain
  • 96 St Pierre Univ Hosp, Brussels, Belgium
  • 97 Univ Ziekenhuis Brussel, Brussels, Belgium
  • 98 Grand Hop Charleroi, Charleroi, Belgium
  • 99 Ghent Univ Hosp, Ghent, Belgium
  • 100 CHR Liege, Liege, Belgium
  • 101 GZA Hosp, Antwerp, Belgium
  • 102 Clin Ctr Univ Sarajevo, Sarajevo, Bosnia & Herceg
  • 103 Univ Fed Sao Paulo, Sao Paulo, Brazil
  • 104 Alberta Hlth Serv, Calgary, AB, Canada
  • 105 Pontificia Univ Catolica Chile, Dept Infect Dis, Sch Med, Santiago, Chile
  • 106 Hosp Calderon Guardia, San Jose, Costa Rica
  • 107 Hosp Mexico, San Jose, Costa Rica
  • 108 Univ Hosp Ctr Zagreb, Zagreb, Croatia
  • 109 Univ Hosp Infect Dis, Zagreb, Croatia
  • 110 Univ Hosp Bristol NHS Fdn Trust, Bristol, Avon, England
  • 111 Tbilisi State Med Univ, Dept Child & Adolescent Med, Tbilisi, Georgia
  • 112 Univ Hosp Erlangen, Dept Paediat & Adolescent Med, Erlangen, Germany
  • 113 Univ Freiburg, Div Pediat Infect Dis & Rheumatol, Dept Paediat & Adolescent Med, Univ Med Ctr,Med Fac, Freiburg, Germany
  • 114 Komfo Anokye Teaching Hosp, Kumasi, Ghana
  • 115 Aristotle Univ Thessaloniki, Hippokrat Hosp, Thessaloniki, Greece
  • 116 Kurdistan Univ Med Sci, Fac Med, Sanandaj, Iran
  • 117 Natl Matern Hosp, Dublin, Ireland
  • 118 Nara Med Univ, Kashihara, Nara, Japan
  • 119 Tohoku Univ Hosp, Sendai, Miyagi, Japan
  • 120 Natl Canc Ctr, Tokyo, Japan
  • 121 Tama Municipal Hosp, Kawasaki, Kanagawa, Japan
  • 122 Appl Sci Private Univ, Fac Phannacy, Amman, Jordan
  • 123 King Fahad Med City, Childrens Hosp Riyadh, Riyadh, Saudi Arabia
  • 124 Natl Inst Publ Hlth Kosovo, Prishtina, Kosovo
  • 125 Univ Prishtina Hasan Prishtina, Prishtina, Kosovo
  • 126 Tolunok Municipal Hosp, Tokmok, Kyrgyzstan
  • 127 Univ Childrens Hosp, Riga, Latvia
  • 128 Univ Latvia, Riga, Latvia
  • 129 Vilnius Univ, Inst Clin Med, Clin Children Dis, Vilnius, Lithuania
  • 130 Inst Publ Hlth, Skopje, North Macedonia
  • 131 Mater Dei Hosp, Msida, Malta
  • 132 Inst Childrens Dis, Podgorica, Montenegro
  • 133 Hlth Insulance Fund, Podgorica, Montenegro
  • 134 Natl Hosp, Abuja, Nigeria
  • 135 Natl Hosp Abuja, Abuja, Nigeria
  • 136 Obafemi Awolowo Univ, Teaching Hosp Complex, Ife, Nigeria
  • 137 Lagos Univ Teaching Hosp, Lagos, Nigeria
  • 138 Ahmadu Bello Univ, Teaching Hosp, Zaria, Nigeria
  • 139 Southern Hlth & Social Care Trust, Craigavon, North Ireland
  • 140 South Eastern Hlth & Social Care Trust, Dundonald, North Ireland
  • 141 Western Hlth & Social Care Trust, Derry, North Ireland
  • 142 Russian Friendship Univ, Moscow, Russia
  • 143 Clin Ctr Serbia, Belgrade, Serbia
  • 144 Singapore Gen Hosp, Singapore, Singapore
  • 145 Stellenbosch Univ, Dept Paediat & Child Hlth, Cape Town, South Africa
  • 146 Virgen Macarena Univ Hosp, Seville, Spain
  • 147 Meander Med Ctr, Amersfoort, Netherlands
  • 148 Haga Hosp, The Hague, Netherlands
  • 149 Sheffield Childrens Hosp, Sheffield, S Yorkshire, England
  • 150 HCA Healthcare, Nashville, TN USA
  • 151 Healthtrust, Sugar Land, TX USA
  • 152 Colleton Med Ctr, Walterboro, SC USA
  • 153 Hosp Corp Amer, Nashville, TN USA
  • 154 Kingwood Med Ctr, Kingwood, TX USA
  • 155 Methodist Hosp, San Antonio, TX USA
Date of creation
20.07.2021
Date of change
20.07.2021
Short link
https://repository.rudn.ru/en/records/article/record/74726/
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