Patterns and potential indications of WHO AWaRe Watch antibiotic use across UK community and hospital care: a national observational study.
13 affiliations
- 1Health Data Sciences (HDS), Translational Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.
- 2Bone and Joint Health, Queen Mary University of London, London, United Kingdom.
- 3Barts Health NHS Trust, NHS Trust, London, United Kingdom.
- 4Barts Life Sciences, Queen Mary University of London, London, United Kingdom.
- 5NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.
- 6Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom.
- 7Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, United Kingdom.
- 8Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
- 9DataLoch, NHS Lothian, Edinburgh, United Kingdom.
- 10Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency (MHRA), London, United Kingdom.
- 11Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom.
- 12Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom.
- 13Department of Medical Informatics, Erasmus MC University, Rotterdam, The Netherlands.
Abstract
There are major concerns regarding the risk of antimicrobial resistance evoked through the inappropriate use of antibiotics. The WHO AWaRe classification has identified antibiotics that have high resistance potential. This cohort study utilized data from seven UK databases, including two community care databases and five hospital databases. The study period was from 2012 to 2025, or from the start of electronic prescription data. Longitudinal trends in Watch antibiotic use and patient demographic information were summarized. Data-driven large-scale characterization was used to identify conditions of interest, and prior use of Access and other Watch antibiotics was summarized. The study included 433 368 hospital and 11 705 843 primary care records of Watch antibiotic use. Quarterly crude incidence rates showed seasonal variation in community prescribing, with rates generally higher in the third and fourth quarters. Although use in community care increased during the COVID-19 pandemic, it remained below prepandemic levels. Most community users were female, while most hospital users were male. Hospital users had more severe conditions, including healthcare-associated infections and sepsis, while community care users were more commonly treated for skin and respiratory tract infections. Prior Access antibiotic use was generally recorded in fewer than 50% of patients. Prior Access of Watch antibiotic use was minimal in community care. Our results highlight the complexity of antibiotic use across different healthcare settings. Regional and demographic variation indicates areas where prescribing practices could be refined. Ongoing surveillance and targeted stewardship interventions are essential to promote appropriate use and prevent resistance.
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BibTeX
@article{rowlands2026patterns,
title = {{Patterns and potential indications of WHO AWaRe Watch antibiotic use across UK community and hospital care: a national observational study.}},
author = {Elin J Rowlands and Cecilia Campanile and Hiba Junaid and Jennifer C E Lane and Usama Rahman and Ben Eaton and Xavier L Griffin and Andy South and Ana Cavalcante and Duncan Cartner and Steve Harris and Ofran Almossawi and Lydia Briggs and Daniel Key and Prasiddha Khadka and Timothy Howcroft and Vishnu Vardhan Chandrabalan and Peter S Hall and Mahéva Vallet and Marta Pasikowska and Nicola Symmers and Colin McLean and Spyro Nita and Daniel Dedman and Zara Cuccu and Stelios Theophanous and Geoff Hall and Martí Català and Daniel Prieto Alhambra and Edward Burn and Danielle Newby},
journal = {European journal of public health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag198},
url = {https://europepmc.org/article/MED/42974914},
note = {CC BY},
}
RIS
TY - JOUR
TI - Patterns and potential indications of WHO AWaRe Watch antibiotic use across UK community and hospital care: a national observational study.
AU - Elin J Rowlands
AU - Cecilia Campanile
AU - Hiba Junaid
AU - Jennifer C E Lane
AU - Usama Rahman
AU - Ben Eaton
AU - Xavier L Griffin
AU - Andy South
AU - Ana Cavalcante
AU - Duncan Cartner
AU - Steve Harris
AU - Ofran Almossawi
AU - Lydia Briggs
AU - Daniel Key
AU - Prasiddha Khadka
AU - Timothy Howcroft
AU - Vishnu Vardhan Chandrabalan
AU - Peter S Hall
AU - Mahéva Vallet
AU - Marta Pasikowska
AU - Nicola Symmers
AU - Colin McLean
AU - Spyro Nita
AU - Daniel Dedman
AU - Zara Cuccu
AU - Stelios Theophanous
AU - Geoff Hall
AU - Martí Català
AU - Daniel Prieto Alhambra
AU - Edward Burn
AU - Danielle Newby
PY - 2026
DA - 2026/10/01
JO - European journal of public health
DO - 10.1093/eurpub/ckag198
UR - https://europepmc.org/article/MED/42974914
AB - There are major concerns regarding the risk of antimicrobial resistance evoked through the inappropriate use of antibiotics. The WHO AWaRe classification has identified antibiotics that have high resistance potential. This cohort study utilized data from seven UK databases, including two community care databases and five hospital databases. The study period was from 2012 to 2025, or from the start of electronic prescription data. Longitudinal trends in Watch antibiotic use and patient demographic information were summarized. Data-driven large-scale characterization was used to identify conditions of interest, and prior use of Access and other Watch antibiotics was summarized. The study included 433 368 hospital and 11 705 843 primary care records of Watch antibiotic use. Quarterly crude incidence rates showed seasonal variation in community prescribing, with rates generally higher in the third and fourth quarters. Although use in community care increased during the COVID-19 pandemic, it remained below prepandemic levels. Most community users were female, while most hospital users were male. Hospital users had more severe conditions, including healthcare-associated infections and sepsis, while community care users were more commonly treated for skin and respiratory tract infections. Prior Access antibiotic use was generally recorded in fewer than 50% of patients. Prior Access of Watch antibiotic use was minimal in community care. Our results highlight the complexity of antibiotic use across different healthcare settings. Regional and demographic variation indicates areas where prescribing practices could be refined. Ongoing surveillance and targeted stewardship interventions are essential to promote appropriate use and prevent resistance.
SN - 1101-1262
SN - 1464-360X
ER -