WHO AWaRe Classification of Antibiotics

Last updated on June 21st, 2021

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

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.

AntibioticClassATC codeCategoryListed on EML 2019
AmikacinAminoglycosidesJ01GB06AccessYes
AmoxicillinPenicillinsJ01CA04AccessYes
Amoxicillin/clavulanic AcidBeta lactam – beta lactamase inhibitorJ01CR02AccessYes
AmpicillinPenicillinsJ01CA01 AccessYes
Ampicillin/sulbactamBeta lactam – beta lactamase inhibitorJ01CR01AccessNo
BacampicillinPenicillinsJ01CA06AccessNo
Benzathine benzylpenicillinPenicillinsJ01CE08AccessYes
BenzylpenicillinPenicillinsJ01CE01AccessYes
CefacetrileFirst-generation cephalosporinsJ01DB10AccessNo
CefadroxilFirst-generation cephalosporinsJ01DB05AccessNo
CefalexinFirst-generation cephalosporinsJ01DB01AccessYes
CefalotinFirst-generation cephalosporinsJ01DB03AccessNo
CefapirinFirst-generation cephalosporinsJ01DB08AccessNo
CefatrizineFirst-generation cephalosporinsJ01DB07AccessNo
CefazedoneFirst-generation cephalosporinsJ01DB06AccessNo
CefazolinFirst-generation cephalosporinsJ01DB04AccessYes
CefradineFirst-generation cephalosporinsJ01DB09AccessNo
CefroxadineFirst-generation cephalosporinsJ01DB11AccessNo
CeftezoleFirst-generation cephalosporinsJ01DB12AccessNo
ChloramphenicolAmphenicolsJ01BA01AccessYes
ClindamycinLincosamidesJ01FF01AccessYes
ClometocillinPenicillinsJ01CE07AccessNo
CloxacillinPenicillinsJ01CF02AccessYes
DicloxacillinPenicillinsJ01CF01AccessNo
DoxycyclineTetracyclinesJ01AA02AccessYes
FlucloxacillinPenicillinsJ01CF05AccessNo
GentamicinAminoglycosidesJ01GB03AccessYes
MecillinamPenicillinsJ01CA11AccessNo
Metronidazole (IV)ImidazolesJ01XD01AccessYes
Metronidazole (oral)ImidazolesP01AB01AccessYes
NafcillinPenicillinsJ01CF06AccessNo
NitrofurantoinNitrofurantoinJ01XE01AccessYes
OxacillinPenicillinsJ01CF04AccessNo
PenamecillinPenicillinsJ01CE06AccessNo
PhenoxymethylpenicillinPenicillinsJ01CE02AccessYes
PivampicillinPenicillinsJ01CA02AccessNo
PivmecillinamPenicillinsJ01CA08AccessNo
Procaine benzylpenicillinPenicillinsJ01CE09AccessYes
SpectinomycinAminocyclitolsJ01XX04AccessYes
Sulfadiazine/trimethoprimTrimethoprim – sulfonamide combinationsJ01EE02AccessNo
Sulfamethizole/trimethoprimTrimethoprim – sulfonamide combinationsJ01EB02AccessNo
Sulfamethoxazole/trimethoprimTrimethoprim – sulfonamide combinationsJ01EE01AccessYes
Sulfametrole/trimethoprimTrimethoprim – sulfonamide combinationsJ01EE03AccessNo
Sulfamoxole/trimethoprimTrimethoprim – sulfonamide combinationsJ01EE04AccessNo
SultamicillinBeta lactam – beta lactamase inhibitorJ01CR04AccessNo
TetracyclineTetracyclinesJ01AA07AccessNo
ThiamphenicolAmphenicolsJ01BA02AccessNo
TrimethoprimTrimethoprimJ01EA01AccessNo

Watch group antibiotics

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.

AntibioticClassATC codeCategoryListed on EML 2019
ArbekacinAminoglycosidesJ01GB12WatchNo
AzithromycinMacrolidesJ01FA10WatchYes
AzlocillinPenicillinsJ01CA09WatchNo
BiapenemCarbapenemsJ01DH05WatchNo
CarbenicillinCarboxypenicillinsJ01CA03WatchNo
CefaclorSecond-generation cephalosporinsJ01DC04WatchNo
CefamandoleSecond-generation cephalosporinsJ01DC03WatchNo
CefbuperazoneSecond-generation cephalosporinsJ01DC13WatchNo
Cefcapene pivoxilThird-generation cephalosporinsJ01DD17WatchNo
CefdinirThird-generation cephalosporinsJ01DD15WatchNo
Cefditoren pivoxilThird-generation cephalosporinsJ01DD16WatchNo
CefepimeFourth-generation cephalosporinsJ01DE01WatchNo
Cefetamet pivoxilThird-generation cephalosporinsJ01DD10WatchNo
CefiximeThird-generation cephalosporinsJ01DD08WatchYes
CefmenoximeThird-generation cephalosporinsJ01DD05WatchNo
CefmetazoleSecond-generation cephalosporinsJ01DC09WatchNo
CefminoxSecond-generation cephalosporinsJ01DC12WatchNo
CefodizimeThird-generation cephalosporinsJ01DD09WatchNo
CefonicidSecond-generation cephalosporinsJ01DC06WatchNo
CefoperazoneThird-generation cephalosporinsJ01DD12WatchNo
CeforanideSecond-generation cephalosporinsJ01DC11WatchNo
CefoselisFourth-generation cephalosporinsto be assignedWatchNo
CefotaximeThird-generation cephalosporinsJ01DD01WatchYes
CefotetanSecond-generation cephalosporinsJ01DC05WatchNo
CefotiamSecond-generation cephalosporinsJ01DC07WatchNo
Cefotiam hexetilSecond-generation cephalosporinsJ01DC07WatchNo
CefoxitinSecond-generation cephalosporinsJ01DC01WatchNo
CefozopranFourth-generation cephalosporinsJ01DE03WatchNo
CefpiramideThird-generation cephalosporinsJ01DD11WatchNo
CefpiromeFourth-generation cephalosporinsJ01DE02WatchNo
Cefpodoxime proxetilThird-generation cephalosporinsJ01DD13WatchNo
CefprozilSecond-generation cephalosporinsJ01DC10WatchNo
CeftazidimeThird-generation cephalosporinsJ01DD02WatchYes
Cefteram pivoxilThird-generation cephalosporinsJ01DD18WatchNo
CeftibutenThird-generation cephalosporinsJ01DD14WatchNo
CeftizoximeThird-generation cephalosporinsJ01DD07WatchNo
CeftriaxoneThird-generation cephalosporinsJ01DD04WatchYes
CefuroximeSecond-generation cephalosporinsJ01DC02WatchYes
ChlortetracyclineTetracyclinesJ01AA03WatchNo
CiprofloxacinFluoroquinolonesJ01MA02WatchYes
ClarithromycinMacrolidesJ01FA09WatchYes
ClofoctolPhenol derivativesJ01XX03WatchNo
DelafloxacinFluoroquinolonesJ01MA23WatchNo
DibekacinAminoglycosidesJ01GB09WatchNo
DirithromycinMacrolidesJ01FA13WatchNo
DoripenemCarbapenemsJ01DH04WatchNo
EnoxacinFluoroquinolonesJ01MA04WatchNo
ErtapenemCarbapenemsJ01DH03WatchNo
ErythromycinMacrolidesJ01FA01WatchNo
FleroxacinFluoroquinolonesJ01MA08WatchNo
FlomoxefSecond-generation cephalosporinsJ01DC14WatchNo
FlumequineFluoroquinolonesJ01MB07WatchNo
Fosfomycin (oral)PhosphonicsJ01XX01WatchNo
Fusidic AcidSteroid antibacterialsJ01XC01WatchNo
GarenoxacinFluoroquinolonesJ01MA19WatchNo
GatifloxacinFluoroquinolonesJ01MA16WatchNo
GemifloxacinFluoroquinolonesJ01MA15WatchNo
Imipenem/cilastatinCarbapenemsJ01DH51WatchNo
IsepamicinAminoglycosidesJ01GB11WatchNo
JosamycinMacrolidesJ01FA07WatchNo
KanamycinAminoglycosidesJ01GB04WatchNo
LatamoxefThird-generation cephalosporinsJ01DD06WatchNo
LevofloxacinFluoroquinolonesJ01MA12WatchNo
LincomycinMacrolidesJ01FF02WatchNo
LomefloxacinFluoroquinolonesJ01MA07WatchNo
LymecyclineTetracyclinesJ01AA04WatchNo
MeropenemCarbapenemsJ01DH02WatchYes
MetacyclineTetracyclinesJ01AA05WatchNo
MezlocillinPenicillinsJ01CA10WatchNo
MicronomicinAminoglycosidesto be assignedWatchNo
MidecamycinMacrolidesJ01FA03WatchNo
Minocycline (oral)TetracyclinesJ01AA08WatchNo
MoxifloxacinFluoroquinolonesJ01MA14WatchNo
NeomycinAminoglycosidesJ01GB05WatchNo
NetilmicinAminoglycosidesJ01GB07WatchNo
NorfloxacinFluoroquinolonesJ01MA06WatchNo
OfloxacinFluoroquinolonesJ01MA01WatchNo
OleandomycinMacrolidesJ01FA05WatchNo
OxytetracyclineTetracyclinesJ01AA06WatchNo
PanipenemCarbapenemsto be assignedWatchNo
PazufloxacinFluoroquinolonesJ01MA18WatchNo
PefloxacinFluoroquinolonesJ01MA03WatchNo
PheneticillinPenicillinsJ01CE05WatchNo
PiperacillinPenicillinsJ01CA12WatchNo
Piperacillin/tazobactamBeta lactam – beta lactamase inhibitor (anti-pseudomonal)J01CR05WatchYes
PristinamycinStreptograminsJ01FG01WatchNo
PrulifloxacinFluoroquinolonesJ01MA17WatchNo
RibostamycinAminoglycosidesJ01GB10WatchNo
RifabutinRifamycinsJ04AB04WatchNo
RifampicinRifamycinsJ04AB02WatchNo
RifamycinRifamycinsJ04AB03WatchNo
RifaximinRifamycinsA07AA11WatchNo
RoxithromycinMacrolidesJ01FA06WatchNo
RufloxacinFluoroquinolonesJ01MA10WatchNo
SisomicinAminoglycosidesJ01GB08WatchNo
SitafloxacinFluoroquinolonesJ01MA21WatchNo
SparfloxacinFluoroquinolonesJ01MA09WatchNo
SpiramycinMacrolidesJ01FA02WatchNo
Spiramycin/metronidazoleCombination of antibioticsJ01RA04WatchNo
StreptomycinAminoglycosidesJ01GA01WatchNo
SulbenicillinPenicillinsJ01CA16WatchNo
TebipenemCarbapenemsJ01DH06WatchNo
TeicoplaninGlycopeptidesJ01XA02WatchNo
TelithromycinMacrolidesJ01FA15WatchNo
TemocillinCarboxypenicillinsJ01CA17WatchNo
TicarcillinCarboxypenicillinsJ01CA13WatchNo
TobramycinAminoglycosidesJ01GB01WatchNo
TosufloxacinFluoroquinolonesJ01MA22WatchNo
Vancomycin (IV)GlycopeptidesJ01XA01WatchYes
Vancomycin (oral)GlycopeptidesA07AA09WatchYes

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.

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.

AntibioticClassATC codeCategoryListed on EML 2019
AztreonamMonobactamsJ01DF01ReserveNo
Ceftaroline fosamilFifth-generation cephalosporinsJ01DI02 ReserveNo
Ceftazidime-avibactamThird-generation cephalosporinsJ01DD52ReserveYes
Ceftobiprole medocarilFifth-generation cephalosporinsJ01DI01ReserveNo
Ceftolozane-tazobactamFifth-generation cephalosporinsJ01DI54ReserveNo
ColistinPolymyxinsJ01XB01ReserveYes
DalbavancinGlycopeptidesJ01XA04ReserveNo
Dalfopristin-quinupristinStreptograminsJ01FG02ReserveNo
DaptomycinLipopeptidesJ01XX09ReserveNo
EravacyclineTetracyclinesJ01AA13ReserveNo
FaropenemPenemsJ01DI03ReserveNo
Fosfomycin (IV)PhosphonicsJ01XX01ReserveYes
LinezolidOxazolidinonesJ01XX08ReserveYes
Meropenem-vaborbactamCarbapenemsJ01DH52ReserveYes
Minocycline (IV)TetracyclinesJ01AA08ReserveNo
OmadacyclineTetracyclinesto be assignedReserveNo
OritavancinGlycopeptidesJ01XA05ReserveNo
PlazomicinAminoglycosidesto be assignedReserveYes
Polymyxin BPolymyxinsJ01XB02ReserveYes
TedizolidOxazolidinonesJ01XX11ReserveNo
TelavancinGlycopeptidesJ01XA03ReserveNo
TigecyclineGlycylcyclinesJ01AA12ReserveNo

References and further readings

Note: This classification and content is reproduced from WHO website.

About Acharya Tankeshwar 473 Articles
Hello, thank you for visiting my blog. I am Tankeshwar Acharya. Blogging is my passion. I am working as an Asst. Professor and Microbiologist at Department of Microbiology and Immunology, Patan Academy of Health Sciences, Nepal. If you want me to write about any posts that you found confusing/difficult, please mention in the comments below.

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