The majority of antibiotics globally are taken orally for conditions such as acute respiratory infections. Recent years have seen a troubling rise in the use of broad-spectrum antibiotics, which are more powerful and have a higher risk of leading to antibiotic resistance. The World Health Organization (WHO) has developed a classification system called AWaRe (Access, Watch, Reserve) to help guide better use of antibiotics:

• Access (Green): Safer, less expensive, and narrow-spectrum antibiotics.
• Watch (Yellow): Broader spectrum, generally more expensive, and with higher safety concerns.
• Reserve (Red): Last resort antibiotics used primarily in hospital settings.

Unfortunately, about half of all antibiotic usage in LMICs involves the more critical Watch or Not Recommended categories. This misuse poses a significant threat to global health, promoting the development of antibiotic-resistant bacteria.

Objectives

The AWaRe 1 Trial aims to:

• Develop and test a new framework for how antibiotics are prescribed and used in primary care settings.
• Establish and evaluate an educational tool for healthcare providers, helping them prescribe antibiotics more effectively based on the WHO AWaRe system.
• Conduct a practical clinical trial to assess the effectiveness of these interventions in reducing the misuse of broad-spectrum antibiotics.

This involves creating simple, traffic-light coded tools (green for Access, yellow for Watch, red for Reserve), based on the 2022 WHO Essential Medicines List AWaRe Antibiotic Handbook, that can easily be used by healthcare professionals to make better prescribing decisions.

By educating healthcare providers and implementing a structured antimicrobial stewardship program, the trial seeks to significantly reduce inappropriate prescriptions of broad-spectrum antibiotics, thereby lowering the risk of antibiotic resistance. This approach not only aims to improve health outcomes but also to establish sustainable practices that can be adopted in similar settings worldwide.