English Adaptation of the WHO AWaRe Index

Source: R/reference.R

This `AWaRe Index' is a classification by the World Health Organisation of key antibiotics into three categories (Sharland et al. 2018) to:

  • improve access (Access)

  • monitor important antibiotics (Watch) and

  • preserve effectiveness of ‘last resort’ antibiotics (Reserve).

It was adapted by Public Health England for antibiotic stewardship and quality improvement in English hospitals (Budd et al. 2019) .

The version included in Ramses contains an additional row for metronidazole J01XD01 administered orally (classified as Access). This is sometimes used in combination with other antibacterials that do not cover anaerobic organisms, but is not present in the Anatomical Therapeutic Chemical (ATC) classification.

reference_aware

Format

A data frame with 208 antimicrobial agents, referenced against the World Health Organisation's Anatomical Therapeutic Chemical (ATC) classification (WHO Collaborating Centre for Drug Statistics Methodology 2020) , Public Health England's AWaRe Indices, and the SNOMED CT medical product concept codes and names. It contains 6 columns:

ATC_code

ATC code of the antibiotic

ATC_route

route of administration as defined in the ATC ("O" = oral; "P" = parenteral; "R" = rectal; "V" = vaginal)

ATC_name

ATC name of the antibiotic

aware_category

AWaRe index ("Access", "Watch", "Reserve")

version

AWaRe Index version (eg. "WHO", "England")

year

AWaRe Index version year

VTM_code

SNOMED CT medicinal product code/Virtual Therapeutic Moiety code in the SNOMED CT UK Drug Extension (NHS Digital 2020)

VTM_name

SNOMED CT medicinal product code/Virtual Therapeutic Moiety name in the SNOMED CT UK Drug Extension (NHS Digital 2020)

Source

Adapted from WHO (2019); Budd et al. (2019) with Virtual Therapeutic Moiety equivalents from the NHS Dictionary of Medicines (dm+d) (NHS Digital 2020) .

References

Budd E, Cramp E, Sharland M, Hand K, Howard P, Wilson P, Wilcox M, Muller-Pebody B, Hopkins S (2019). “Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe.” Journal of Antimicrobial Chemotherapy, 74(11), 3384-3389. ISSN 0305-7453, doi:10.1093/jac/dkz321 .

NHS Digital (2020). “SNOMED CT® UK Drug Extension Model. Version 1.3 (published 17/08/2020).” https://hscic.kahootz.com/gf2.ti/f/762498/91346757.1/PDF/-/doc_SnomedCTUKDrugExtensionModel_-_v1.3.pdf.

Sharland M, Pulcini C, Harbarth S, Zeng M, Gandra S, Mathur S, Magrini N (2018). “Classifying antibiotics in the WHO Essential Medicines List for optimal use--be AWaRe.” The Lancet Infectious Diseases, 18(1), 18--20. ISSN 14733099, doi:10.1016/S1473-3099(17)30724-7 .

WHO Collaborating Centre for Drug Statistics Methodology (2020). “ATC classification index with DDDs, 2020.” https://www.whocc.no/atc_ddd_index/.

WHO (2019). “The 2019 WHO AWaRe classification of antibiotics for evaluation and monitoring of use.” (WHO/EMP/IAU/2019.11), https://apps.who.int/iris/bitstream/handle/10665/327957/WHO-EMP-IAU-2019.11-eng.xlsx.

Examples

data("reference_aware")
head(reference_aware)
#>   ATC_code ATC_route                                 ATC_name aware_category
#> 1  J01GB06         P                                 amikacin          Watch
#> 2  J01CA04         P                              amoxicillin         Access
#> 3  J01CA04         O                              amoxicillin         Access
#> 4  J01CR02         O amoxicillin and beta-lactamase inhibitor          Watch
#> 5  J01CR02         P amoxicillin and beta-lactamase inhibitor          Watch
#> 6  J01CA01         O                               ampicillin         Access
#>   version year VTM_code     VTM_name
#> 1 England 2019 48836000     Amikacin
#> 2 England 2019 27658006  Amoxicillin
#> 3 England 2019 27658006  Amoxicillin
#> 4 England 2019 89519005 Co-amoxiclav
#> 5 England 2019 89519005 Co-amoxiclav
#> 6 England 2019 31087008   Ampicillin