UK public health officials have updated the list of which antibiotics can be prescribed and when, as part of efforts to tackle antimicrobial resistance.

It has meant some shuffling of antibiotic choices between the ‘access, watch and reserve’ or AWaRe categories set out by the World Health Organization (WHO).

All first-generation cephalosporins are now classed as ‘access’ instead of ‘watch’ antibiotics, the UK Health Security Agency (UKHSA) said, which means they should be used to treat the most common infections.

The move which covers cefadroxil, cefalexin, cefazolin and cefradine does not ‘mandate increased use of cephalosporins’, the guidelines stated and all other cephalosporins remain in the watch or reserve categories.

But it means that patients with certain allergies, such as to penicillin, can be prescribed a wider range of antibiotics ‘that currently show less potential to develop resistance to bacteria than others’, UKHSA added.

However, officials have made a decision to keep amoxicillin/clavulanic acid in the watch category in the UK despite WHO guidance moving it to the least restrictive access list.

This is because in the UK setting specifically, experts judged that ‘its use is more likely to develop resistance in bacteria compared to other antibiotics’, UKHSA added.

The guidance, which is included in an NHS antimicrobial stewardship tool will apply across the four devolved nations and follows advice from WHO which updated its categories in 2023.

Use of antibiotics in the watch or reserve categories is carefully monitored as part of antibiotic stewardship programmes.

By 2029, the UK is aiming to achieve 70% of total use of antibiotics from the access category to preserve the usefulness in the future, which according to the latest figures from 2023 is 64.1% for England.

Dr Colin Brown, deputy director at UKHSA said: ‘The AWaRe classification has played an important role in antibiotic stewardship in the UK and continues to do so.

‘This review for the UK will help healthcare professionals choose the best treatment options for their patients, while preserving the effectiveness of antibiotics for future use.’

He added: ‘It will also support the development of guidelines for antibiotic prescribing and our UK targets to tackle antibiotic resistance set out in the National Action Plan.

‘Appropriate use of antibiotics is essential in our fight against resistant bacteria.'

A version of this article first appeared on our sister publication Pulse.