Researchers have uncovered a serious global problem with antibiotic use, with most countries over-prescribing certain types, while a large number of patients are denied access to the life-saving treatments they need.
The study included 186 countries and provided scientific estimates of the appropriate quantity and types of antibiotics that each country should use, based on local infection rates and antibiotic resistance.
The World Health Organization classifies antibiotics into three main categories, known as the "AWaRe" system: the "Access" category, which includes antibiotics such as amoxicillin, which are daily first-line treatments suitable for most common infections; the "Watch" category, which includes stronger drugs that should be reserved for specific cases where simpler antibiotics do not work; and the "Reserve" category, which are last-resort treatments for more serious and drug-resistant infections.
In 2024, world leaders at the United Nations agreed that at least 70% of global antibiotic use should be in the "access" category by 2030, but the challenge was the lack of a way to determine the right balance of antibiotics for each individual country.
For this reason, the research team developed a framework that groups countries into similar categories based on shared characteristics, including poverty levels, infectious disease rates, antibiotic resistance, and the strength of local healthcare systems. Within each group, countries with the lowest antibiotic consumption and infection mortality rates were used as benchmarks to determine the optimal use of similar countries.
According to the researchers, in 2019, approximately 43 billion courses of antibiotics were needed globally—an average of one course per person per year—to treat all bacterial infections. Around 77% of these courses should have been considered "accessible," suggesting that the UN's 70% target is achievable.
But when these estimates were compared with actual data from 67 countries, alarming results emerged; it turned out that about three-quarters of the countries use quantities of antibiotics that exceed the actual need, and almost all countries (99%) overuse antibiotics in the “monitored” category , the overuse of which is associated with an increased risk of antibiotic resistance.
Conversely, more than half of countries did not use enough "reserve" antibiotics , meaning that patients with drug-resistant and life-threatening infections may not receive necessary treatments. It was also found that 60% of countries are still using antibiotics that the World Health Organization believes should no longer be prescribed.
The study also highlighted a significant global disparity: low- and middle-income countries, which face a greater burden of infectious diseases and drug resistance, require higher proportions of "monitoring" and "precautionary" antibiotics than wealthier nations. However, high-income countries are currently the largest users of these types of antibiotics.
The researchers believe that this framework can provide countries with a practical tool to assess the suitability of antibiotic use to their circumstances, and to address the problems of overuse and inappropriate use of specific types of antibiotics, calling for the development of national policies to reduce unnecessary prescriptions and improve access to these drugs for patients who actually need them.
The study results were published in The Lancet Public Health journal.
