Implikasi Perbedaan Klasifikasi AWaRe WHO Dan Kemenkes RI Terhadap Evaluasi Penggunaan Antibiotik: Tinjauan Literatur

Abstract

The AWaRe classification was developed by the WHO to support antimicrobial stewardship through standardized evaluation of antibiotic use. Several countries, including Indonesia, have implemented AWaRe classifications adapted to national clinical needs and policy priorities, although such adaptations may lead to variations in the interpretation of antibiotic use indicators and stewardship performance. A literature search was conducted using the Google Scholar database with the keywords “AWaRe classification”, “antibiotic use evaluation”, “WHO”, and “Indonesia”, accompanied by the addition of the affixes "AND" and "OR", and selection by the publication date starting January 2023, and ten (10) studies met the inclusion criteria. The selected studies were analyzed using thematic and comparative synthesis to identify patterns of antibiotic consumption, dominance of AWaRe categories, and the impact of classification differences on stewardship indicators. The included studies covered outpatient care (30%), inpatient care (30%), intensive care units (20%), community pharmacies (10%), and national antibiotic distribution (10%). Most studies (90%) reported dominance of Watch antibiotics, while increased use of Reserve antibiotics (40%) and Watch antibiotics dominated the DU90% segment (80%) of studies. Indonesian studies (20%) showed that national adaptation of the AWaRe classification increased the apparent proportion of Access antibiotics by approximately 15–30%.  In conclusion, AWaRe is a valuable tool for monitoring antibiotic use; however, stewardship interpretation is highly sensitive to the classification system applied. Dual reporting using both WHO and national AWaRe classifications is recommended to ensure accurate, transparent, and globally comparable evaluation of antibiotic use in support of effective antimicrobial stewardship policies.