They found that 77% of global antibiotic use should be Access antibiotics, suggesting the UN's 70% target is reasonable.
Nearly three-quarters (72%) of countries analysed were using more antibiotics in total than needed, and almost every country (99%) prescribed too many Watch antibiotics, which contribute the most to antibiotic resistance.
Worryingly, 60% of countries were still using antibiotics that the WHO considers should no longer be prescribed.
We have developed the first practical way for countries to estimate how much of each type of antibiotic their populations need based on infection burden and antibiotic resistance.
This framework can help move the conversation beyond measuring antibiotic consumption to matching antibiotic use with public health need.
Our findings show the world faces a double challenge - while some antibiotics are being overused, millions of people may still lack access to the medicines they need to treat their infections Aislinn Cook
The team calculated that in 2019, around 43 billion days of antibiotics were needed globally, averaging out to roughly one antibiotic course per person per year, to treat all bacterial infections appropriately. They found that 77% of global antibiotic use should be Access antibiotics, suggesting the UN's 70% target is reasonable.
Although higher-income countries currently use the most Watch and Reserve antibiotics, the study estimates that more than 80% of the world's optimal need for these medicines lies in lower-income countries, where infectious disease and antimicrobial resistance burdens are highest.
The researchers then compared their estimates with real-world antibiotic use data from 67 countries where this data was available. Nearly three-quarters (72%) of countries analysed were using more antibiotics in total than needed, and almost every country (99%) prescribed too many Watch antibiotics, which contribute the most to antibiotic resistance. Worryingly, 60% of countries were still using antibiotics that the WHO considers should no longer be prescribed.
At the same time, 42% of countries were using fewer Access antibiotics than estimated optimal levels, and more than half (52%) were not using enough Reserve antibiotics than estimated to be needed. This means patients with life-threatening drug-resistant infections might not be receiving the specific treatments they need.
The findings suggest that many countries could improve antibiotic use by reducing unnecessary Watch antibiotic prescribing while increasing access to essential Access antibiotics, and ensuring availability of Reserve antibiotics for patients with highly resistant infections.
Aislinn Cook, lead author and Senior Research Fellow in Infectious Diseases Epidemiology at City St George’s School of Health & Medical Sciences, said: “Our findings show the world faces a double challenge - while some antibiotics are being overused, millions of people may still lack access to the medicines they need to treat their infections. We have developed the first practical way for countries to estimate how much of each type of antibiotic their populations need based on infection burden and antibiotic resistance. This framework can help move the conversation beyond measuring antibiotic consumption to matching antibiotic use with public health need. This can support countries to develop more targeted policies to reduce overuse while ensuring sustainable access to effective antibiotics.”
