Reserve list for antimicrobial drugs

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The issue

Antimicrobial resistant infections are becoming more frequent and difficult to treat. For this reason, they're a growing public health threat in Canada and around the world.

Health Canada authorizes antimicrobial drugs (such as antibiotics) for sale in Canada. Promoting the appropriate use of these drugs helps maintain Canada's high public health standards.

About the reserve list

Among its initiatives related to antimicrobial resistant infections, Health Canada has created a reserve list of antimicrobial drugs.

The antimicrobial drugs on the list should be reserved for treating confirmed or suspected infections from multi-drug resistant organisms. Treating them as last-resort options preserves their effectiveness, ensuring they will work when they're needed.

This list is a reference document for prescribers.

A health care provider should prescribe a drug on this list only when necessary after considering all other treatment options and weighing the clinical evidence. At least 1 of the following conditions should be met:

By indicating which antimicrobial drugs should be used sparingly, the reserve list:

The reserve list supports Health Canada's mandate to protect and promote the health of people in Canada. It's also part of several initiatives that the Government of Canada is undertaking in line with the Pan-Canadian Action Plan on Antimicrobial Resistance.

What's included in the reserve list

The reserve list includes the following antimicrobial drugs (in alphabetical order):

Health Canada has authorized these drugs for use in Canada, but some may not be currently marketed here. Access the Drug Product Database to find:

How we developed the reserve list

Other countries around the world use antimicrobial classification systems to help preserve the effectiveness of last-resort antimicrobial drugs. At the moment, all these systems only include antibacterials in their classifications.

Health Canada modelled Canada's reserve list after the reserve category of the World Health Organization's (WHO) AWaRe classification system. WHO's system has 3 categories of antibiotics:

We also examined the classification systems used in England and Australia. We put together a draft list of all antibacterials classified as "reserve" and "watch" by WHO, England and Australia.

We cross-referenced WHO's list with our Drug Product Database to include only antibacterials that we have authorized for sale in Canada. Next, we refined the list after looking at Canadian antimicrobial use and antimicrobial resistance data and consulted experts across Canada, such as:

We then asked for public feedback by holding a consultation for 60 days from August to October 2023. We used this feedback to finalize the list.

Criteria considered in the reserve list includes:

Criteria not considered in the reserve list includes:

Updates to the list

We will update the list as needed to reflect the latest antibacterial drugs that we have authorized for sale in Canada. We will review the list periodically to consider:

Contact us

Contact us if you would like a summary of the feedback we received when developing the reserve list or if you have questions or comments.

Pharmaceutical Drugs Directorate
Health Products and Food Branch
Address Locator: 3105A
Health Canada
Ottawa ON  K1A 0K9

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Health Canada


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