Annex 2: AWaRe Classification

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Access Group Antibiotics

This group includes 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.

 

Sl no.  

Antibiotic

Class

1.  

Amikacin

Aminoglycosides

2.  

Amoxicillin

Penicillins 

3.  

Amoxicillin/clavulanic Acid

Beta lactam - beta lactamase inhibitor

4.  

Ampicillin

Penicillins 

5.  

Benzylpenicillin

Penicillins 

6.  

Cefadroxil

First-generation cephalosporins

7.  

Cefalexin

First-generation cephalosporins

8.  

Cefazolin

First-generation cephalosporins

9.  

Cefradine

First-generation cephalosporins

10.  

Chloramphenicol

Amphenicols

11.  

Clindamycin

Lincosamides

12.  

Cloxacillin

Penicillins 

13.  

Doxycycline

Tetracyclines

14.  

Flucloxacillin

Penicillins 

15.  

Gentamicin

Aminoglycosides

16.  

Mecillinam

Penicillins 

17.  

Metronidazole (IV)

Imidazoles

18.  

Metronidazole (oral)

Imidazoles

19.  

Nitrofurantoin

Nitrofurantoin

20.  

Oxacillin

Penicillins 

21.  

Phenoxymethylpenicillin

Penicillins 

22.  

Pivmecillinam

Penicillins 

23.  

Procaine benzylpenicillin

Penicillins 

24.  

Spectinomycin

Aminocyclitols

25.  

Sulfadiazine/trimethoprim

Trimethoprim - sulfonamide combinations

26.  

Sulfamethizole/trimethoprim

Trimethoprim - sulfonamide combinations

27.  

Sulfamethoxazole/trimethoprim

Trimethoprim - sulfonamide combinations

28.  

Tetracycline

Tetracyclines

Watch Group Antibiotics

This group includes antibiotic classes that have higher resistance potential and includes most of the highest priority agents among the Critically Important Antimicrobials for Human Medicine1 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.

Sl No.

Antibiotic

Class

1.  

Azithromycin

Macrolides

2.  

Cefaclor

Second-generation cephalosporins

3.  

Cefamandole

Second-generation cephalosporins

4.  

Cefepime

Fourth-generation cephalosporins

5.  

Cefixime

Third-generation cephalosporins

6.  

Cefotaxime

Third-generation cephalosporins

7.  

Cefpodoxime proxetil

Third-generation cephalosporins

8.  

Ceftazidime

Third-generation cephalosporins

9.  

Ceftibuten

Third-generation cephalosporins

10.  

Ceftriaxone

Third-generation cephalosporins

11.  

Cefuroxime

Second-generation cephalosporins

12.  

Ciprofloxacin

Fluoroquinolones

13.  

Clarithromycin

Macrolides

14.  

Erythromycin

Macrolides

15.  

Fosfomycin (oral)

Phosphonics

16.  

Fusidic Acid

Steroid antibacterials

17.  

Gatifloxacin

Fluoroquinolones

18.  

Gemifloxacin

Fluoroquinolones

19.  

Imipenem/cilastatin

Carbapenems

20.  

Kanamycin

Aminoglycosides

21.  

Levofloxacin

Fluoroquinolones

22.  

Lomefloxacin

Fluoroquinolones

23.  

Minocycline (oral)

Tetracyclines

24.  

Moxifloxacin

Fluoroquinolones

25.  

Neomycin

Aminoglycosides

26.  

Netilmicin

Aminoglycosides

27.  

Norfloxacin

Fluoroquinolones

28.  

Ofloxacin

Fluoroquinolones

29.  

Pefloxacin

Fluoroquinolones

30.  

Piperacillin

Penicillins 

31.  

Piperacillin/tazobactam

Beta lactam - beta lactamase inhibitor (anti-pseudomonal)

32.  

Rifampicin

Rifamycins

33.  

Rifamycin

Rifamycins

34.  

Rifaximin

Rifamycins

35.  

Roxithromycin

Macrolides

36.  

Sparfloxacin

Fluoroquinolones

37.  

Spiramycin

Macrolides

38.  

Streptomycin

Aminoglycosides

39.  

Tobramycin

Aminoglycosides

40.  

Vancomycin (IV)

Glycopeptides

41.  

Vancomycin (oral)

Glycopeptides

Reserve Group Antibiotics

"This group includes antibiotics and antibiotic classes that should be reserved for treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Reserve group antibiotics should be treated as “last resort” options.

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 List1, 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."

 

 Sl No.

Antibiotic

Class

1.  

Aztreonam

Monobactams

2.  

Colistin

Polymyxins

3.  

Fosfomycin (IV)

Phosphonics

4.  

Linezolid

Oxazolidinones

5.  

Minocycline (IV)

Tetracyclines

6.  

Polymyxin B

Polymyxins

7.  

Tedizolid

Oxazolidinones

8.  

Tigecycline

Glycylcyclines

Note: Only the antibiotics which are available in Bangladesh are included in this classification.