Antibiotic Classification and Stewardship

Introduction to Antibiotic Classification

• The World Health Organization (WHO) AWaRe framework categorizes antibiotics into Access, Watch, and Reserve groups based on their resistance potential and clinical importance for antimicrobial stewardship, which includes antibiotics such as amoxicillin, trimethoprim-sulfamethoxazole, and doxycycline as Access (Green) group examples 1

Antibiotic Classification by Mechanism

• Antibiotics can be classified based on how they kill or inhibit bacteria, including Cell Wall Synthesis Inhibitors (e.g., β-lactams, glycopeptides), Protein Synthesis Inhibitors (e.g., aminoglycosides, macrolides), Nucleic Acid Synthesis Inhibitors (e.g., fluoroquinolones), Metabolic Pathway Inhibitors (e.g., trimethoprim, sulfonamides), and Cell Membrane Disruptors (e.g., polymyxins, daptomycin) 1

Antibiotic Classification by Structure

• Antibiotics can be grouped by their structural similarities, including β-lactams (e.g., penicillins, cephalosporins, carbapenems), macrolides (e.g., azithromycin, clarithromycin), tetracyclines (e.g., doxycycline, minocycline), aminoglycosides (e.g., gentamicin, amikacin), and fluoroquinolones (e.g., ciprofloxacin, levofloxacin) 1

Antibiotic Classification by Spectrum

• Antibiotics can be classified as narrow-spectrum (targeting specific types of bacteria) or broad-spectrum (effective against many bacterial types), with examples including vancomycin (narrow-spectrum, gram-positive focused) and carbapenems (broad-spectrum) 1

Treatment Guidelines for Specific Infections

• For skin and soft tissue infections, the first choice (Access) antibiotics are dicloxacillin and cefalexin, with vancomycin and linezolid (Reserve) recommended for MRSA coverage 1
• For bacterial diarrhea, the first choice (Access) antibiotic is trimethoprim-sulfamethoxazole, with azithromycin and ciprofloxacin (Watch) as second choices 1