Developing AWaRe-ness in primary care across low- and middle-income countries: a vital challenge for antibiotic stewardship programs

Antimicrobial Resistance (AMR) is a growing global public health challenge, particularly among low- and middle-income countries (LMICs). AMR is exacerbated by high levels of inappropriate prescribing and dispensing of antibiotics among LMICs. To address this, the World Health Organization and others have launched several initiatives. These include the Global Action Plan, promoting the AWaRe classification and guidance as well as encouraging antimicrobial stewardship programmes (ASPs). There have also been initiatives to reduce the prevalence of substandard and falsified antibiotics. More co-ordinated activities are needed though to reduce rising AMR among LMICs and the consequences. However, key challenges remain. These include current variable knowledge of antibiotics, AMR and ASPs among all key stakeholder groups, including patients, and variable antibiotic resistance surveillance in primary care. In addition, issues of affordability encouraging the informal sector. Interlocking activities include encouraging increased awareness of AWaRe and guidance among all key groups, implementing ASPs in primary care along with quality indicators based on AWaRe, and encouraging greater co-ordinated activities to reduce the extent of substandard and falsified antibiotics. Overall, multiple activities are needed to improve antibiotic access and use in primary care, including promoting AWaRe-ness and ASPs. Working together, AMR can be reduced and health improved.