A spokesperson from the UK Health Security Agency highlighted key updates in the 2024 UK-AWaRe classification, aligning them with national AMR goals.
WHO AWaRe Book
Image credits: WHO
A modified Delphi approach led to the development of a UK-adapted version of the WHO’s AWaRe (Access, Watch, Reserve) antibiotic classification, designed to align with national antimicrobial stewardship (AMS) priorities. This adaptation supports efforts to improve antibiotic use across primary and secondary care settings in the UK.
In a four-stage modified Delphi survey, 61 experts across the UK participated in assessing and refining the WHO’s 2023 AWaRe antibiotic categories based on UK-specific antibiotic resistance profiles and current stewardship practices. In an email interview, a spokesperson from the UK Health Security Agency stated, "The proposed 2024 UK-AWaRe classification is aligned with 81% of the WHO’s 2023 AWaRe classification, with 17 antibiotics differing in categorization. The most notable difference is that Amoxicillin/clavulanic acid (co-amoxiclav) remains in the Watch classification from our 2019 England-AWaRe classification, compared to Access for the WHO AWaRe classification."
The consensus reached through the Delphi process emphasizes the importance of clear messaging, particularly around key changes. One significant reclassification involves the shift of first-generation cephalosporins, previously categorized under the Watch group, into the Access category. This move aligns with the UK’s updated AMS objectives and reflects the global WHO standards. As the spokesperson explained, "This change is the most significant difference between the 2024 UK-AWaRe classification and the 2019 England classification. It means that patients with certain allergies, such as penicillin, will have access to a wider range of antibiotics that currently show less potential to develop resistance to bacteria than others."
The spokesperson further highlighted, "The classification for cephalosporins now aligns with the WHO’s classifications, compared to 2019 England classification where all cephalosporins were in the Watch category."
A case study using England's national antibiotic consumption data from 2018 to 2022 demonstrated that Access antibiotics accounted for over 60% of total human antibiotic use. The proposed UK-AWaRe classification slightly reduces this percentage to 63.7%, compared to 69.7% using the WHO's 2023 version.
The 2024 UK-AWaRe classification moves first-generation cephalosporins from the Watch category to Access, improving accessibility for patients with allergies
The UK aims for 70% of total antibiotic use to come from the Access category by 2029 as part of its antimicrobial resistance action plan.
Data from national antibiotic consumption shows a slight reduction in Access antibiotics use from 69.7% in the WHO 2023 classification to 63.7% in the UK-adapted version.
This adaptation plays a large role in the UK’s antimicrobial resistance (AMR) action plan for 2024–2029, which is centered around enhancing stewardship practices and meeting national antibiotic usage targets. The spokesperson elaborated on the national action plan’s commitment, "By 2029, the UK is aiming to achieve 70% of total use of antibiotics from the UK-Adapted Access category across the human healthcare system to preserve efficacy."
The Delphi process and the data-driven insights it provided are expected to inform ongoing AMS practices. As the spokesperson concluded, "Achieving 70% of total use of antibiotics from the new UK Access category is an ambitious task as the UK will be reporting against the new UK-modified AWaRe classification. From the case study modelled in the manuscript, Access antibiotics as a proportion of total antibiotic use in England was higher when using the WHO 2023 classification, compared with the proposed UK-adapted 2024 classification; in 2022, 69.66% of total antibiotic use was Access antibiotics where Access antibiotics were defined using the WHO 2023 classification, compared with 63.67% using the nationally adapted UK-AWaRe classification."
