A major international clinical trial aiming to improve the use of antibiotics in primary care has officially opened and welcomed its first patients in Bangladesh.
By Lisa Jones (Press and Research Communications Manager), Published
Antibiotics are the most prescribed medicines, with around 90% of global antibiotics use being a result of visits to primary care settings such as clinics and health centres.
They play a vital role in treating infections, but many people are still being given strong antibiotics they don’t need - especially for minor respiratory illnesses such as coughs and colds. These stronger medicines can be more expensive, cause more side effects and increase the risk of antibiotic resistance, which makes infections harder to treat in the future.
The AWaRe-1 trial, led by Professor Mike Sharland from City St George’s Institute for Infection and Immunity, is a multi-country trial testing an educational intervention based on a new antibiotic classification system called AWaRe (Access, Watch, Reserve). By giving doctors and nurses in low- and middle-income countries practical tools based on the AWaRe system, the study will support them in choosing the right antibiotics for the patients they care for while protecting antibiotics for future generations.
The AWaRe system, developed by the World Health Organization (WHO) with involvement from Professor Sharland, divides antibiotics into three categories:
- ‘Access’ antibiotics are safer, less expensive, and narrow-spectrum antibiotics.
- ‘Watch’ antibiotics have a broader spectrum, generally more expensive and come with higher safety and resistance concerns.
- ‘Reserve’ antibiotics are last resort antibiotic and typically used in hospitals.
The trial, funded by Wellcome, will involve nearly 10,000 patients and hundreds of health professionals from 96 public health centres across Bangladesh, Indonesia, Vietnam and Nigeria. It will test practical tools for both healthcare providers and patients - such as training materials and decision guides - based on the WHO’s AWaRe system and the WHO AWaRe book, providing detailed guidance on the treatment of 35 of the most common infections. These tools are designed to help shift habits and improve how antibiotics are prescribed and used.
Using the AWaRe system, the team aims to strengthen evidence for antibiotic stewardship policies aligned with the United Nations’ Antimicrobial Resistance (AMR) target that 70% of global antibiotic use should be from the WHO ‘Access’ group.
Professor Mike Sharland, Chief Investigator of the AWaRe-1 Project, said:
“We’re especially proud that this trial is being led by our partners in countries where very few primary care trials on optimal antibiotic use have been done before.”
Professor Wasif Khan from the team at the International Centre for Diarrheal Disease Research in Bangladesh, said:
“We believe that the impact of the AWaRe1 trial would improve prescription practices through evidence-based guidelines, encouraging more prudent antibiotic use in primary care settings and assisting in the development of public health policies.”
The study is being carried out by a global team of researchers and public health experts, including collaborators from the Universities of Oxford, East Anglia, Cape Town, KCL and Universitas Gadjah Mada, Radboud University Medical Center, Hanoi Medical University, Lagos State University College of Medicine, Universitas Gadjah Mada in Indonesia and the International Centre for Diarrhoeal Disease Research in Bangladesh, alongside partners across Africa, Asia, and Europe.
Professor Max Bachmann, co-Chief Investigator of the AWaRe-1 trial, from University of East Anglia, said: