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Certain antibiotics are overused in most countries, while too few people receive the specific antibiotic treatments they need, according to a study of antibiotic use across 186 countries published in The Lancet Public Health journal. The study provides scientific estimates of how many and which types of antibiotics each country could be expected to use ideally, based on local rates of infection and antibiotic resistance.
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Antibiotics are grouped by the World Health Organization (WHO) into three categories, known as the "AWaRe" system:
- Access antibiotics, such as amoxicillin, are everyday first-line treatments suitable for most common infections.
- Watch antibiotics are stronger medicines that should be saved for specific conditions where simpler antibiotics won't work.
- Reserve antibiotics are last-resort treatments for the most dangerous drug-resistant infections.
In 2024, world leaders at the United Nations agreed that at least 70% of antibiotic use worldwide should come from the Access group by 2030. However, no method previously existed to determine the right balance of antibiotics for any individual country.
To fill this gap, the research team developed a framework that groups countries into peer clusters based on shared characteristics, including poverty levels, rates of infectious disease, antibiotic resistance and the strength of local health care systems. Within each cluster, countries with the lowest antibiotic use and the fewest infection-related deaths were used as benchmarks to determine what optimal antibiotic use should look like for similar countries.
The researchers calculated that in 2019, around 43 billion courses of antibiotics were needed globally, averaging roughly one antibiotic course per person per year, to treat all bacterial infections. Of those, about 77% should have been Access antibiotics, suggesting the U.N.'s 70% target is reasonable.
But when researchers compared these estimates with real-world data from 67 countries, they found that nearly three-quarters of countries were using more antibiotics overall than needed. Additionally, almost every country (99%) was overusing Watch antibiotics. When overused, Watch antibiotics contribute the most to antibiotic resistance.
At the same time, more than half of countries and territories with available real-world data were not using enough Reserve antibiotics, meaning patients with life-threatening drug-resistant infections might not be receiving the treatments they need. Additionally, 60% of countries were still using antibiotics that WHO considers should no longer be prescribed.
The study also highlights an important global inequality. Low- and middle-income countries, which face heavier burdens of infectious disease and drug resistance, need proportionally more specialized Watch and Reserve antibiotics than wealthier nations. However, higher-income countries are currently using these types of antibiotics the most.
The authors say the framework can give countries a practical tool to assess whether their antibiotic use is broadly appropriate for their situation and address both overuse and the inappropriate use of certain antibiotics. They call for national policies to reduce unnecessary prescribing and improve access for patients who genuinely need these medicines.
More information: Aislinn Cook et al, Estimating optimal levels of WHO Access, Watch, Reserve (AWaRe) antibiotic use in 186 countries, territories, and areas on the basis of clinical infection and resistance burden, The Lancet Public Health (2026). DOI: 10.1016/s2468-2667(26)00103-9
Provided by Lancet
This story was originally published on Medical Xpress.
