5.1 Global-scale measures

OIE guidelines

The World Organisation for Animal Health (OIE) has classified 3GCs as ‘very important antimicrobials’ for treating animals, and provides the following recommendations to preserve the effectiveness of 3GC for treatment of illness in both animals and humans (OIE, 2018):

  • Not to be used as preventive treatment applied in feed or water in the absence of clinical signs of illness in the animal(s) to be treated.
  • Not to be used as first line treatment unless justified. When used as a second line treatment, it should ideally be based on the results of bacteriological tests.
  • Extra label/off-label use should be limited and reserved for instances where no alternatives are available. Such use should be in agreement with the national legislation in force.

WHO guidelines

The World Health Organization (WHO) has identified 3GCs as ‘critically important antimicrobials’ to help formulate and prioritise risk assessment and risk management strategies for containing AMR, mainly due to non-human antimicrobial use (WHO, 2019a).

The WHO classifies antibiotics for human use into three stewardship groups: Access, Watch and Reserve (AWaRe), as described below. The majority of 3GCs, including ceftriaxone, are in the Watch group, which includes most of the highest priority critically important antimicrobials for human medicine. The WHO recommends that ‘antibiotics in the “Watch” group should be prioritized as key targets of stewardship programs and antimicrobial use monitoring’. The AWaRe database [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] can be accessed from the WHO website (WHO, 2019c).

The WHO’s AWaRe classification

Access antibiotics ‘have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups.’

Watch antibiotics ‘have higher resistance potential and include most of the highest priority agents among the critically important antimicrobials for human medicine and/or antibiotics that are at relatively high risk of selection of bacterial resistance. Antibiotics in the Watch group should be prioritized as key targets of stewardship programs and monitoring.’

Reserve antibiotics ‘include antibiotics and antibiotic classes that should be reserved for treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Antibiotics in the Reserve group should be treated as “last resort” options.’

5 A One Health approach to controlling AMR

5.2 National-scale measures: industry controls and national regulations