WHO AWaRe Classification of Antibiotics
WHO AWaRe Classification of Antibiotics
Access, Watch, Reserve (AWaRe) classification of antibiotics was developed by World Health Organization (WHO) to assist in the development of tools for antibiotic stewardship at local, national, and global levels and to reduce antimicrobial resistance. AwaRe classified antibiotics into different groups to emphasize the importance of their appropriate use.
This classification is intended to be used as a tool for countries to better support antibiotic monitoring and stewardship activities.
The aim of the WHO AWaRe antibiotic categorization is to provide a tool to use antibiotics safely and effectively.
Access group antibiotics
| Antibiotic | Class | ATC code | Category | Listed on EML 2019 |
| --- | --- | --- | --- | --- |
| Amikacin | Aminoglycosides | J01GB06 | Access | Yes |
| Amoxicillin | Penicillins | J01CA04 | Access | Yes |
| Amoxicillin/clavulanic Acid | Beta lactam – beta lactamase inhibitor | J01CR02 | Access | Yes |
| Ampicillin | Penicillins | J01CA01 | Access | Yes |
| Ampicillin/sulbactam | Beta lactam – beta lactamase inhibitor | J01CR01 | Access | No |
| Bacampicillin | Penicillins | J01CA06 | Access | No |
| Benzathine benzylpenicillin | Penicillins | J01CE08 | Access | Yes |
| Benzylpenicillin | Penicillins | J01CE01 | Access | Yes |
| Cefacetrile | First-generation cephalosporins | J01DB10 | Access | No |
| Cefadroxil | First-generation cephalosporins | J01DB05 | Access | No |
| Cefalexin | First-generation cephalosporins | J01DB01 | Access | Yes |
| Cefalotin | First-generation cephalosporins | J01DB03 | Access | No |
| Cefapirin | First-generation cephalosporins | J01DB08 | Access | No |
| Cefatrizine | First-generation cephalosporins | J01DB07 | Access | No |
| Cefazedone | First-generation cephalosporins | J01DB06 | Access | No |
| Cefazolin | First-generation cephalosporins | J01DB04 | Access | Yes |
| Cefradine | First-generation cephalosporins | J01DB09 | Access | No |
| Cefroxadine | First-generation cephalosporins | J01DB11 | Access | No |
| Ceftezole | First-generation cephalosporins | J01DB12 | Access | No |
| Chloramphenicol | Amphenicols | J01BA01 | Access | Yes |
| Clindamycin | Lincosamides | J01FF01 | Access | Yes |
| Clometocillin | Penicillins | J01CE07 | Access | No |
| Cloxacillin | Penicillins | J01CF02 | Access | Yes |
| Dicloxacillin | Penicillins | J01CF01 | Access | No |
| Doxycycline | Tetracyclines | J01AA02 | Access | Yes |
| Flucloxacillin | Penicillins | J01CF05 | Access | No |
| Gentamicin | Aminoglycosides | J01GB03 | Access | Yes |
| Mecillinam | Penicillins | J01CA11 | Access | No |
| Metronidazole (IV) | Imidazoles | J01XD01 | Access | Yes |
| Metronidazole (oral) | Imidazoles | P01AB01 | Access | Yes |
| Nafcillin | Penicillins | J01CF06 | Access | No |
| Nitrofurantoin | Nitrofurantoin | J01XE01 | Access | Yes |
| Oxacillin | Penicillins | J01CF04 | Access | No |
| Penamecillin | Penicillins | J01CE06 | Access | No |
| Phenoxymethylpenicillin | Penicillins | J01CE02 | Access | Yes |
| Pivampicillin | Penicillins | J01CA02 | Access | No |
| Pivmecillinam | Penicillins | J01CA08 | Access | No |
| Procaine benzylpenicillin | Penicillins | J01CE09 | Access | Yes |
| Spectinomycin | Aminocyclitols | J01XX04 | Access | Yes |
| Sulfadiazine/trimethoprim | Trimethoprim – sulfonamide combinations | J01EE02 | Access | No |
| Sulfamethizole/trimethoprim | Trimethoprim – sulfonamide combinations | J01EB02 | Access | No |
| Sulfamethoxazole/trimethoprim | Trimethoprim – sulfonamide combinations | J01EE01 | Access | Yes |
| Sulfametrole/trimethoprim | Trimethoprim – sulfonamide combinations | J01EE03 | Access | No |
| Sulfamoxole/trimethoprim | Trimethoprim – sulfonamide combinations | J01EE04 | Access | No |
| Sultamicillin | Beta lactam – beta lactamase inhibitor | J01CR04 | Access | No |
| Tetracycline | Tetracyclines | J01AA07 | Access | No |
| Thiamphenicol | Amphenicols | J01BA02 | Access | No |
| Trimethoprim | Trimethoprim | J01EA01 | Access | No |
Access group includes 48 antibiotics that have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups.
Selected Access group antibiotics are recommended as essential first or second-choice empiric treatment options for infectious syndromes reviewed by the EML Expert Committee and are listed as individual medicines on the Model Lists of Essential Medicines to improve access and promote appropriate use.
Watch group antibiotics
| Antibiotic | Class | ATC code | Category | Listed on EML 2019 |
| --- | --- | --- | --- | --- |
| Arbekacin | Aminoglycosides | J01GB12 | Watch | No |
| Azithromycin | Macrolides | J01FA10 | Watch | Yes |
| Azlocillin | Penicillins | J01CA09 | Watch | No |
| Biapenem | Carbapenems | J01DH05 | Watch | No |
| Carbenicillin | Carboxypenicillins | J01CA03 | Watch | No |
| Cefaclor | Second-generation cephalosporins | J01DC04 | Watch | No |
| Cefamandole | Second-generation cephalosporins | J01DC03 | Watch | No |
| Cefbuperazone | Second-generation cephalosporins | J01DC13 | Watch | No |
| Cefcapene pivoxil | Third-generation cephalosporins | J01DD17 | Watch | No |
| Cefdinir | Third-generation cephalosporins | J01DD15 | Watch | No |
| Cefditoren pivoxil | Third-generation cephalosporins | J01DD16 | Watch | No |
| Cefepime | Fourth-generation cephalosporins | J01DE01 | Watch | No |
| Cefetamet pivoxil | Third-generation cephalosporins | J01DD10 | Watch | No |
| Cefixime | Third-generation cephalosporins | J01DD08 | Watch | Yes |
| Cefmenoxime | Third-generation cephalosporins | J01DD05 | Watch | No |
| Cefmetazole | Second-generation cephalosporins | J01DC09 | Watch | No |
| Cefminox | Second-generation cephalosporins | J01DC12 | Watch | No |
| Cefodizime | Third-generation cephalosporins | J01DD09 | Watch | No |
| Cefonicid | Second-generation cephalosporins | J01DC06 | Watch | No |
| Cefoperazone | Third-generation cephalosporins | J01DD12 | Watch | No |
| Ceforanide | Second-generation cephalosporins | J01DC11 | Watch | No |
| Cefoselis | Fourth-generation cephalosporins | to be assigned | Watch | No |
| Cefotaxime | Third-generation cephalosporins | J01DD01 | Watch | Yes |
| Cefotetan | Second-generation cephalosporins | J01DC05 | Watch | No |
| Cefotiam | Second-generation cephalosporins | J01DC07 | Watch | No |
| Cefotiam hexetil | Second-generation cephalosporins | J01DC07 | Watch | No |
| Cefoxitin | Second-generation cephalosporins | J01DC01 | Watch | No |
| Cefozopran | Fourth-generation cephalosporins | J01DE03 | Watch | No |
| Cefpiramide | Third-generation cephalosporins | J01DD11 | Watch | No |
| Cefpirome | Fourth-generation cephalosporins | J01DE02 | Watch | No |
| Cefpodoxime proxetil | Third-generation cephalosporins | J01DD13 | Watch | No |
| Cefprozil | Second-generation cephalosporins | J01DC10 | Watch | No |
| Ceftazidime | Third-generation cephalosporins | J01DD02 | Watch | Yes |
| Cefteram pivoxil | Third-generation cephalosporins | J01DD18 | Watch | No |
| Ceftibuten | Third-generation cephalosporins | J01DD14 | Watch | No |
| Ceftizoxime | Third-generation cephalosporins | J01DD07 | Watch | No |
| Ceftriaxone | Third-generation cephalosporins | J01DD04 | Watch | Yes |
| Cefuroxime | Second-generation cephalosporins | J01DC02 | Watch | Yes |
| Chlortetracycline | Tetracyclines | J01AA03 | Watch | No |
| Ciprofloxacin | Fluoroquinolones | J01MA02 | Watch | Yes |
| Clarithromycin | Macrolides | J01FA09 | Watch | Yes |
| Clofoctol | Phenol derivatives | J01XX03 | Watch | No |
| Delafloxacin | Fluoroquinolones | J01MA23 | Watch | No |
| Dibekacin | Aminoglycosides | J01GB09 | Watch | No |
| Dirithromycin | Macrolides | J01FA13 | Watch | No |
| Doripenem | Carbapenems | J01DH04 | Watch | No |
| Enoxacin | Fluoroquinolones | J01MA04 | Watch | No |
| Ertapenem | Carbapenems | J01DH03 | Watch | No |
| Erythromycin | Macrolides | J01FA01 | Watch | No |
| Fleroxacin | Fluoroquinolones | J01MA08 | Watch | No |
| Flomoxef | Second-generation cephalosporins | J01DC14 | Watch | No |
| Flumequine | Fluoroquinolones | J01MB07 | Watch | No |
| Fosfomycin (oral) | Phosphonics | J01XX01 | Watch | No |
| Fusidic Acid | Steroid antibacterials | J01XC01 | Watch | No |
| Garenoxacin | Fluoroquinolones | J01MA19 | Watch | No |
| Gatifloxacin | Fluoroquinolones | J01MA16 | Watch | No |
| Gemifloxacin | Fluoroquinolones | J01MA15 | Watch | No |
| Imipenem/cilastatin | Carbapenems | J01DH51 | Watch | No |
| Isepamicin | Aminoglycosides | J01GB11 | Watch | No |
| Josamycin | Macrolides | J01FA07 | Watch | No |
| Kanamycin | Aminoglycosides | J01GB04 | Watch | No |
| Latamoxef | Third-generation cephalosporins | J01DD06 | Watch | No |
| Levofloxacin | Fluoroquinolones | J01MA12 | Watch | No |
| Lincomycin | Macrolides | J01FF02 | Watch | No |
| Lomefloxacin | Fluoroquinolones | J01MA07 | Watch | No |
| Lymecycline | Tetracyclines | J01AA04 | Watch | No |
| Meropenem | Carbapenems | J01DH02 | Watch | Yes |
| Metacycline | Tetracyclines | J01AA05 | Watch | No |
| Mezlocillin | Penicillins | J01CA10 | Watch | No |
| Micronomicin | Aminoglycosides | to be assigned | Watch | No |
| Midecamycin | Macrolides | J01FA03 | Watch | No |
| Minocycline (oral) | Tetracyclines | J01AA08 | Watch | No |
| Moxifloxacin | Fluoroquinolones | J01MA14 | Watch | No |
| Neomycin | Aminoglycosides | J01GB05 | Watch | No |
| Netilmicin | Aminoglycosides | J01GB07 | Watch | No |
| Norfloxacin | Fluoroquinolones | J01MA06 | Watch | No |
| Ofloxacin | Fluoroquinolones | J01MA01 | Watch | No |
| Oleandomycin | Macrolides | J01FA05 | Watch | No |
| Oxytetracycline | Tetracyclines | J01AA06 | Watch | No |
| Panipenem | Carbapenems | to be assigned | Watch | No |
| Pazufloxacin | Fluoroquinolones | J01MA18 | Watch | No |
| Pefloxacin | Fluoroquinolones | J01MA03 | Watch | No |
| Pheneticillin | Penicillins | J01CE05 | Watch | No |
| Piperacillin | Penicillins | J01CA12 | Watch | No |
| Piperacillin/tazobactam | Beta lactam – beta lactamase inhibitor (anti-pseudomonal) | J01CR05 | Watch | Yes |
| Pristinamycin | Streptogramins | J01FG01 | Watch | No |
| Prulifloxacin | Fluoroquinolones | J01MA17 | Watch | No |
| Ribostamycin | Aminoglycosides | J01GB10 | Watch | No |
| Rifabutin | Rifamycins | J04AB04 | Watch | No |
| Rifampicin | Rifamycins | J04AB02 | Watch | No |
| Rifamycin | Rifamycins | J04AB03 | Watch | No |
| Rifaximin | Rifamycins | A07AA11 | Watch | No |
| Roxithromycin | Macrolides | J01FA06 | Watch | No |
| Rufloxacin | Fluoroquinolones | J01MA10 | Watch | No |
| Sisomicin | Aminoglycosides | J01GB08 | Watch | No |
| Sitafloxacin | Fluoroquinolones | J01MA21 | Watch | No |
| Sparfloxacin | Fluoroquinolones | J01MA09 | Watch | No |
| Spiramycin | Macrolides | J01FA02 | Watch | No |
| Spiramycin/metronidazole | Combination of antibiotics | J01RA04 | Watch | No |
| Streptomycin | Aminoglycosides | J01GA01 | Watch | No |
| Sulbenicillin | Penicillins | J01CA16 | Watch | No |
| Tebipenem | Carbapenems | J01DH06 | Watch | No |
| Teicoplanin | Glycopeptides | J01XA02 | Watch | No |
| Telithromycin | Macrolides | J01FA15 | Watch | No |
| Temocillin | Carboxypenicillins | J01CA17 | Watch | No |
| Ticarcillin | Carboxypenicillins | J01CA13 | Watch | No |
| Tobramycin | Aminoglycosides | J01GB01 | Watch | No |
| Tosufloxacin | Fluoroquinolones | J01MA22 | Watch | No |
| Vancomycin (IV) | Glycopeptides | J01XA01 | Watch | Yes |
| Vancomycin (oral) | Glycopeptides | A07AA09 | Watch | Yes |
The Watch group includes 110 antibiotics that have higher resistance potential and includes most of the highest priority agents among the Critically Important Antimicrobials for Human Medicine and/or antibiotics that are at relatively high risk of selection of bacterial resistance. These medicines should be prioritized as key targets of stewardship programs and monitoring. Selected Watch group antibiotics are recommended as essential first or second-choice empiric treatment options for a limited number of specific infectious syndromes and are listed as individual medicines on the WHO Model Lists of Essential Medicines.
Reserve group antibiotics
Reserve group includes antibiotics and antibiotic classes that should be reserved for the treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Reserve group antibiotics should be treated as “last resort” options.
| Antibiotic | Class | ATC code | Category | Listed on EML 2019 |
|---|---|---|---|---|
| Aztreonam | Monobactams | J01DF01 | Reserve | No |
| Ceftaroline fosamil | Fifth-generation cephalosporins | J01DI02 | Reserve | No |
| Ceftazidime-avibactam | Third-generation cephalosporins | J01DD52 | Reserve | Yes |
| Ceftobiprole medocaril | Fifth-generation cephalosporins | J01DI01 | Reserve | No |
| Ceftolozane-tazobactam | Fifth-generation cephalosporins | J01DI54 | Reserve | No |
| Colistin | Polymyxins | J01XB01 | Reserve | Yes |
| Dalbavancin | Glycopeptides | J01XA04 | Reserve | No |
| Dalfopristin-quinupristin | Streptogramins | J01FG02 | Reserve | No |
| Daptomycin | Lipopeptides | J01XX09 | Reserve | No |
| Eravacycline | Tetracyclines | J01AA13 | Reserve | No |
| Faropenem | Penems | J01DI03 | Reserve | No |
| Fosfomycin (IV) | Phosphonics | J01XX01 | Reserve | Yes |
| Linezolid | Oxazolidinones | J01XX08 | Reserve | Yes |
| Meropenem-vaborbactam | Carbapenems | J01DH52 | Reserve | Yes |
| Minocycline (IV) | Tetracyclines | J01AA08 | Reserve | No |
| Omadacycline | Tetracyclines | to be assigned | Reserve | No |
| Oritavancin | Glycopeptides | J01XA05 | Reserve | No |
| Plazomicin | Aminoglycosides | to be assigned | Reserve | Yes |
| Polymyxin B | Polymyxins | J01XB02 | Reserve | Yes |
| Tedizolid | Oxazolidinones | J01XX11 | Reserve | No |
| Telavancin | Glycopeptides | J01XA03 | Reserve | No |
| Tigecycline | Glycylcyclines | J01AA12 | Reserve | No |
Selected Reserve group antibiotics are listed as individual medicines on the WHO Model Lists of Essential Medicines when they have a favorable risk-benefit profile and proven activity against “Critical Priority” or “High Priority” pathogens identified by the WHO Priority Pathogens List, notably carbapenem-resistant Enterobacteriaceae. These antibiotics should be accessible, but their use should be tailored to highly specific patients and settings when all alternatives have failed or are not suitable. These medicines could be protected and prioritized as key targets of national and international stewardship programs involving monitoring and utilization reporting, to preserve their effectiveness.
References and further readings
Note: This classification and content is reproduced from WHO website.