Identifying AWaRe indicators for appropriate antibiotic use: a narrative review.

Area of Science:

• Antimicrobial Stewardship
• Health Services Research
• Infectious Diseases

Background:

• Quality indicators (QIs) are crucial for effective antibiotic stewardship programmes.
• The World Health Organization (WHO) developed the Access, Watch, Reserve (AWaRe) system to categorize antibiotics based on resistance selection potential.
• Existing QIs for antibiotic use require evaluation to inform the development of future AWaRe-based QIs.

Purpose of the Study:

• To identify and analyze existing quality indicators for optimal antibiotic use.
• To assess the alignment of current indicators with the guidance provided by the WHO AWaRe system.
• To inform the development of new, globally applicable AWaRe-based quality indicators for antibiotic stewardship.

Main Methods:

• Conducted a comprehensive literature search in PubMed for articles on antibiotic use QIs in hospital and primary care settings.
• Extracted data on infection type, healthcare setting, quality assessment targets, and indicator development methodology.
• Identified indicators that reflect the principles and guidance of the AWaRe system.

Main Results:

• A total of 773 antibiotic use QIs were identified, primarily targeting health service management, antibiotic consumption, and prescribing/dispensing practices.
• Indicators were similarly distributed across primary and secondary care, with a significant focus on respiratory tract infections.
• While only 1% of indicators explicitly mentioned the AWaRe system, 57.6% reflected its underlying guidance.

Conclusions:

• Numerous quality indicators for appropriate antibiotic use exist, but few are directly based on the WHO AWaRe system.
• There is a significant need for the development of globally applicable, AWaRe-aligned indicators.
• Integrating AWaRe-based indicators into antibiotic stewardship programmes is essential for optimizing antibiotic use and combating resistance.