AWaRe Classification Of Antibiotics

AWaRe Classification Of Antibiotics
21 Nov 2023
10 mins
Table Of Content
AWaRe Classification Of Antibiotics

    "Secure tomorrow, with wise antibiotic play,

    For a healthier future, start that way."


    Have you ever wondered how the antibiotics that safeguard our health can transform into a looming health issue known as antimicrobial resistance? Indeed, antibiotics can be like a double-edged sword. If you use them wisely, they offer immense benefits, but misuse can lead to adverse effects. So, how do we become aware of the proper handling of antibiotics? Continue to read for more information.


    Know About Antibiotics


    Antibiotics are a group of medicines that treat bacterial infections in our body. They act by killing bacteria and preventing them from multiplying. The doctor usually prescribes these antibiotics to treat bacterial infections. 

    Over time, certain bacteria develop their ability to survive against antibiotic exposure and continue to grow instead of being killed, which is called antibiotic resistance. This leads to the resistance of microbes, which makes the body refuse any antibiotics. This worsens the situation by making it harder to cure the infection.


    AWaRe A Global Breakthrough


    To overcome this, the World Health Organisation (WHO) has initiated a proactive step by establishing a classification of antibiotics. It was first developed in 2017 by the World Health Organisation Expert Committee on the Selection and Use of Essential Medicines. 

    The World Health Organisation estimated that more than five million people have died due to antibiotic resistance all over the world. This is due to the lack of awareness about the proper use of antibiotics.

    The aim of the AWaRe classification is to monitor antibiotic consumption, define targets of the antibiotics, and monitor the effects of stewardship policies that optimize the use of antibiotics and check antimicrobial resistance.


    General Classification Of Antibiotics


    Antibiotics are classified into different types based on different factors; some of the classifications of antibiotics are given below:


    1. Classification based on the origin of antibiotics


    This type of classification is based on the origin of antibiotics, in which the nature of microorganisms is produced. Some of the antibiotics produced by Streptomyces species and Actinomycetes are given below:


    • Aburamycin
    • Azomycin
    • Bottromycin
    • Carbomycin
    • Chloramphenicol
    • Fervenulin
    • Formycin B
    • Gentamicin
    • Histidomycin
    • Mycoheptin
    • Neomycin
    • Polymyxin
    • Siomycin
    • Taitomycin,
    • Undecylprodigios




    Even though this classification can place a large group of antibiotics in a single class, it is difficult to identify their individual taxonomic families.


    2. Classification based on biosynthesis


    The biosynthetic pathway refers to a series of reactions that modify the starting bioproduct into another product form; based on this pathway, antibiotics can be classified. It is generally derived from two or three primary molecules which turn into a complex molecule.


    • Macrolides
    • Polyenes
    • Tetracyclines
    • Terpenes
    • Polyines




    It often leads to confusion when similar metabolic pathways are shared for different antibiotic formations.


    3. Classification based on the spectrum


    Based on the spectrum of antibiotics, it can be classified into four types. Spectrum activity of antibiotics refers to the range of bacteria or microorganisms it can target and kill. Some of the spectrum-based classifications of antibiotics are given below:


    1. Broad-spectrum antibiotics, e.g. Ampicillin.
    2. Narrow-spectrum antibiotics, e.g. Penicillin G.
    3. Extended-spectrum antibiotics, e.g. Beta-lactam.
    4. Spectrum-specific antibiotics, e.g. Rifampicin.




    Using broad-spectrum antibiotics targets many types of bacteria, leading to antibiotic resistance when not needed.


    4. Classification based on the mechanism of action


    Antibiotics can be classified based on the mechanism of action in which they inhibit or kill bacteria. It is divided into seven types, which are given below:


    • Cell wall synthesis inhibitors. e.g. Amoxicillin
    • Protein synthesis inhibitors, e.g., Streptomycin
    • Nucleic acid synthesis inhibitors, e.g. Rifampin
    • Metabolic pathway inhibitors, e.g., Trimethoprim
    • Cell membrane disruptors, e.g., colistin
    • Inhibitors of bacterial folate synthesis, e.g., Trimethoprim
    • Antibiotics affecting multiple targets, e.g., Linezolid (Linoplus 200mg Injection)




    It is difficult to identify antibiotics like gramicidin S, which have different mechanisms of action (oxidative phosphorylation). Antibiotics with similar chemical structures often share identical modes of action. This leads to difficulty in identifying the antibiotics.


    5. Classification based on chemical 


    Based on chemical structure, antibiotics can be classified into different types, which are given below:


    • β-lactam antibiotics
    • Aminoglycoside antibiotics
    • Tetracycline antibiotics
    • Polypeptide antibiotics
    • Macrolide antibiotics
    • Lincomycins




    Even though there is a large number of chemical structures present in the antibiotics, it is difficult to identify most antibiotics that were discovered recently (many new macrolides, polyenes, polyethers, and oligopeptides containing unusual amino acid residues have been described recently).


    AWaRe Classification Of Antibiotics


    The World Health Organisation has classified antibiotics into three groups based on the impact of different antibiotics and antibiotic classes on antimicrobial resistance. This was updated by the WHO every two years. The three groups of antibiotics in AWaRe are given below:


    • Access: As denoted by the word access, it is the group of an easily accessible antibiotic compared to other AWaRe groups. It has a narrow spectrum activity, low cost, and a good safety profile. Generally, this has a low resistance potential and is recommended as a first or second choice for common infections. E.g., Amoxicillin.
    • Watch: The watch antibiotics group has a broader spectrum, which needs proper monitoring and prioritized as a target antibiotic. These antibiotics are generally highly expensive and are advised only as first-choice options for patients with more severe infections where the causative pathogens are more likely to be resistant to Access antibiotics (e.g., upper urinary tract infections). e.g., Azithromycin, erythromycin.
    • Reserve: These antibiotics are used to treat multidrug-resistant infections and are kept as a last choice. It needs intense monitoring and is used only under specific conditions. e.g., Omadacycline, dalbavancin.


    Unlocking Antibiotic Power: The Essentials Of AWaRE Classification


    • It helps to monitor the effect of antibiotic stewardship (an effort to measure and improve the use of antibiotics prescribed by clinicians and used by patients) and can reduce the misuse and help to slow the emergence of antibiotic resistance.
    • It acts as a tool for monitoring antibiotic consumption.
    • To achieve a success rate and reduce the risk of treatment failure in major surgeries and cancer chemotherapy, which involves the administration of antibiotics.
    • It helps to provide an easily interpretable framework for broad assessment of patterns of narrow-spectrum and broad-spectrum antibiotic use.




    The AWaRE classification of antibiotics represents a comprehensive framework that helps to understand antibiotics in a better way. We need to ensure the correct use of antibiotics to avoid antibiotic resistance, which leads to the death of millions of people. This can be achieved by classifying the antibiotics in a better way. AWaRe helps us to understand the effect of antibiotics and ensure the proper use of it. We need more proactive steps like AWaRe to overcome the global crisis of antibiotic resistance.


    "Preserving antibiotic effectiveness through the AWaRe classification isn't just a goal; it's a responsibility we owe to future generations."

    Written by
    Dr Archana GuptaContent writer
    AboutDr. Archana is a Medical Content Writer at MrMed. She graduated with a Bachelor of Dentistry (BDS) from Surendera Dental College, Ganganangar, Rajasthan in 2019. She participated in various aspects of clinical services, and research projects and has written various blogs and articles. She is proficient in researching, writing, editing, and proofreading of medical content and blogs.
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