Antibiotics & WHO AWaRe Classification: India’s AMR Challenge

Subject: GS 2: Social Justice

Context: A study published in The Lancet Public Health found that India is overusing powerful ‘Watch’ category antibiotics, while underusing both ‘Access’ and ‘Reserve’ antibiotics. 

• It is the first global framework to estimate countries’ antibiotic requirements based on their infection burden and Antimicrobial Resistance (AMR) patterns. 

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About Antibiotics

• Antibiotics are antimicrobial medicines used to treat bacterial infections by killing bacteria or preventing their multiplication. 
  • They are ineffective against viral infections such as the common cold, influenza, or most sore throats.
• Antimicrobial Resistance (AMR): A condition in which microorganisms (such as bacteria, viruses, fungi, and parasites) no longer respond to antimicrobial medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.

WHO AWaRe Classification

• AWaRe: A WHO classification system for antibiotics that groups them into Access, Watch, and Reserve categories based on their spectrum of activity, potential to drive antimicrobial resistance (AMR), and recommended patterns of use.

• Examples of Antibiotics: 
• • Commonly used Watch antibiotics: Ceftriaxone, Cefixime, Azithromycin, Ciprofloxacin, Levofloxacin, Piperacillin–Tazobactam.
  • Reserve antibiotics: Meropenem, Colistin, Ceftazidime–Avibactam, Cefiderocol, Aztreonam–Avibactam.

Key Findings of the Study Related to India

• Mismatch Between Recommended and Actual Antibiotic Use: The study estimates that India ideally requires 14.7 Defined Daily Doses (DID) of antibiotics per 1,000 people per day, comprising:
  • Access: 7.8 DID
  • Watch: 6 DID
  • Reserve: 0.99 DID
• However, actual antibiotic consumption is 18.3 DID, comprising:
  • Access: 4.5 DID (lower than required)
  • Watch: 9.3 DID (higher than required)
  • Reserve: 0.19 DID (far lower than required)
• Low Use of ‘Access’ Antibiotics: Only 27% of antibiotic use belongs to the ‘Access’ category, against an estimated requirement of 52.3%.

Global Findings

• Study Coverage: Researchers analysed antibiotic use across 186 countries and territories, representing 99.8% of the world’s population.
• Excessive Overall Antibiotic Use: 72% of countries used more antibiotics overall than estimated to be necessary.
• Overuse of AMR-Driving Antibiotics: 99% of countries prescribed excessive quantities of antibiotics that contribute most to antimicrobial resistance (AMR).

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Measures to be Taken as suggested by the Study

• Strengthen Antimicrobial Stewardship: Enhance antimicrobial stewardship programmes to promote rational antibiotic use.
• Increase Use of ‘Access’ Antibiotics: Promote greater use of ‘Access‘ antibiotics where clinically appropriate.
• Restrict ‘Watch’ Antibiotics: Limit ‘Watch’ antibiotics to specific clinical indications.
• Reserve ‘Reserve’ Antibiotics: Use ‘Reserve‘ antibiotics only for documented or strongly suspected multidrug-resistant infections.
• Promote Evidence-Based Prescribing: Improve microbiological testing to support evidence-based antibiotic prescriptions.
• Enhance Infection Prevention: Strengthen infection prevention practices and ensure rational surgical prophylaxis.

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