Access, Watch and Reserve antibiotic classification
The AWaRe Classification of antibiotics was developed as a tool by WHO to support antibiotic stewardship efforts. Antibiotics are classified into three groups, Access, Watch and Reserve, taking into account the impact of different antibiotics and antibiotic classes on antimicrobial resistance. The UK utilises a modified version of the WHO list; the UK list was updated in 2025 (see table below).
- Access: The antibiotic of choice for most common infection offers the best therapeutic value, while minimising the potential for resistance.
- Watch: Only indicated for specific, limited number of infective syndromes.
- Reserve: Antibiotics that should only be used as a last resort when all other antibiotics have failed.
|
Access |
Watch |
Reserve |
|
Amoxicillin Benzathine Benzylpenicillin Benzylpenicillin Cefalexin Cefazolin Cefradine Co-trimoxazole Doxycycline Flucloxacillin Fosfomycin (PO) Gentamicin Metronidazole Nitrofurantoin Phenoxymethypenicillin Pivmecillinam Procaine-benzylpenicillin Tetracycline Tinidazole Trimethoprim
|
Amikacin Co-amoxiclav Azithromycin Cefaclor Cefepime Cefixime Cefotaxime Cefoxitin Ceftazidime Ceftriaxone Cefuroxime Chloramphenicol Ciprofloxacin Clarithromycin Clindamycin Delafloxacin Erythromycin Fidaxomicin Fusidic acid Levofloxacin Lymecycline Minocycline Moxifloxacin Ofloxacin Oxytetracycline Piperacillin/Tazobactam Teicoplanin Temocillin Tobramycin Vancomycin |
Aztreonam Ceftaroline Cefiderocol Ceftazidime with avibactam (Zavicefta®) Ceftolozane with tazobactam Colistimethate sodium Dalbavancin Daptomycin Ertapenem Fosfomycin (IV) Imipenem Imipenem-cilastatin-relebactam (Recarbrio®) Linezolid Meropenem Meropenem-vaborbactam (Vaborem®) Oritavancin Tigecycline
|
Pre-authorisation of Antimicrobial prescriptions: certain antimicrobials require Micro/ID approval BEFORE prescribing or administration. Contact Micro/ID to discuss (Infection consults - how to access help). Respiratory medicine consultants may also recommend certain antmicrobials.
|
Antimicrobial |
Requires Micro/ID approval |
Can be advised by Respiratory |
|
Amikacin |
Yes |
Yes for non-TB mycobacterium in CF patients and MDR-TB only (Registrar or consultant recommendation) |
|
Atovaquone |
Yes |
No |
|
Aztreonam |
Yes |
Yes |
|
Cefazolin |
Yes except for indications in antimicrobial guidelines e.g pre-op prophylaxis, Soft tissue injury - established infection, Cellulitis, peri-orbital, Facial cellulitis (excluding pinna), Cellulitis, lower or upper limb) |
No |
|
Cefiderocol |
Yes |
No |
|
Cefoxitin |
Yes |
Yes for non-TB mycobacterium in CF only |
|
Ceftaroline |
Yes |
No |
|
Ceftazidime with avibactam (Zavicefta®) |
Yes |
No |
|
Ceftolozane with tazobactam |
Yes |
No |
|
Cefuroxime |
Yes |
No |
|
Chloramphenicol |
Yes except for Meningitis: community-acquired with severe penicillin allergy |
No |
|
Colistimethate sodium |
Yes |
Yes |
|
Cycloserine |
Yes |
No |
|
Dalbavancin |
Yes except for indications in antimicrobial guidelines e.g. Cellulitis, lower or upper limb |
No |
|
Dapsone |
Yes except for PCP prophylaxis |
No |
|
Daptomycin |
Yes |
No |
|
Ertapenem |
Yes |
No |
|
Imipenem |
Yes |
No |
|
Imipenem-cilastatin-relebactam (Recarbrio®) |
Yes |
No |
|
Linezolid |
Yes |
No |
|
Meropenem |
Yes except for indications in antimicrobial guidelines e.g transplant and BIU |
No |
|
Meropenem-vaborbactam (Vaborem®) |
Yes |
No |
|
Minocycline |
Yes |
No |
|
Piperacillin-tazobactam |
Yes except for indications in antimicrobial guidelines e.g. Neutropenic sepsis, Systemic sepsis after organ transplantation, Diabetic foot infection, severe Infected abdominal collections associated with pancreatic transplant, |
No |
|
Pristinamycin |
Yes |
No |
|
Streptomycin |
Yes |
No |
|
Temocillin |
Yes |
Yes for CF patients only (Consultant recommendation only) |
|
Tigecycline |
Yes |
Yes for non-TB mycobacterium in CF patients only (Consultant recommendation only) |