Foodborne Disease Surveillance

WHO list of Critically Important Antimicrobials (CIA)

Use of antimicrobials in food animals can create an important source of antimicrobial resistant bacteria that can spread to humans through the food supply. Improved management of the use of antimicrobials in food animals, particularly reducing those critically important for human medicine, is an important step towards preserving the benefits of antimicrobials for people. The World Health Organization (WHO) has developed and applied criteria to rank antimicrobials according to their relative importance in human medicine. Clinicians, regulatory agencies, policy-makers and other stakeholders can use this ranking when developing risk management strategies for the use of antimicrobials in food production animals. The use of the list will help preserve the effectiveness of currently available antimicrobials.

The first WHO list of CIA was developed in the 1st WHO Expert Meeting on Critically Important Antimicrobials for Human Health held in Canberra, Australia, 2005. During the meeting, participants considered the list of all antimicrobial classes used in human medicine and categorized antimicrobials into three groups of critically important, highly important, and important based on the two criteria developed during the meeting.

The 1st revision of the WHO list of CIA was developed in the 2nd WHO Expert Meeting on Critically Important Antimicrobials for Human Health held in Copenhagen, Denmark, 2007. In this meeting, participants reviewed the two criteria and re-examined the categorization of all human antibacterial classes to prepare the 2nd edition of the list. Participants also prioritized agents within the critically important category in order to allow allocation of resources on the agents for which management of the risks from antimicrobial resistance are needed most urgently.

The list has subsequently been re-examined and updated during WHO-AGISAR expert meetings held in Copenhagen in 2009 (2nd revision) and in Oslo, Norway in 2011 (3rd revision).

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