antimicrobial resistance

A new global study has found that nearly every country is overusing powerful antibiotics that are meant to be reserved for severe infections, raising concerns over the growing threat of antimicrobial resistance (AMR). The findings, published in The Lancet Public Health, suggest that inappropriate use of these medicines is accelerating the spread of drug-resistant bacteria. Researchers from the University of London and other institutions developed a framework to estimate the ideal level and type of antibiotic use for individual countries. They say the tool can help governments assess whether their antibiotic prescribing patterns are appropriate and guide efforts to curb both excessive and inappropriate antibiotic use. The World Health Organization (WHO) categorises antibiotics under its Access, Watch and Reserve (AWaRe) classification. ‘Access’ antibiotics, such as amoxicillin, are recommended as first-line treatments for common bacterial infections. ‘Watch’ antibiotics are stronger drugs that should only be used when standard treatments are ineffective, while ‘Reserve’ antibiotics are considered last-resort medicines for life-threatening drug-resistant infections. In 2024, the United Nations General Assembly endorsed the AWaRe framework as the global standard for antibiotic monitoring and set a target for at least 70% of antibiotic use worldwide to come from the Access category by 2030. However, researchers noted that no country-specific benchmarks had been established until now. The study grouped countries into four clusters based on factors including income levels, infectious disease burden and antibiotic resistance. Using 2019 data, the researchers estimated that around 43 billion antibiotic treatment courses were required globally, averaging approximately one course per person annually. They concluded that nearly 77% of these should ideally come from the Access category, reinforcing the UN’s 70% target. When researchers compared these estimates with actual antibiotic consumption data from 67 countries and territories, they found widespread misuse. Around 72% of the countries consumed more antibiotics overall than necessary, while 99% exceeded the expected use of Watch antibiotics. The analysis also found that more than half of the countries were underusing Reserve antibiotics, suggesting that some patients with serious drug-resistant infections may not be receiving the specialised treatments they require. Additionally, 60% of the countries continued prescribing antibiotics that the WHO no longer recommends. India, which falls under the study’s second cluster, was estimated to require between 9.9 and 14.7 defined daily doses (DDD) per 1,000 inhabitants per day (DID). However, the country’s actual antibiotic use stood at 18.3 DID, with Watch antibiotics accounting for 9.3 DID and Access antibiotics making up only 4.5 DID. The researchers also highlighted a significant global disparity. Low- and middle-income countries, which face a greater burden of infectious diseases and antimicrobial resistance, require relatively higher access to specialised Watch and Reserve antibiotics. Yet, wealthier nations currently consume these medicines at much higher rates. The authors urged governments to adopt stronger national antibiotic stewardship policies that reduce unnecessary prescriptions while ensuring patients with genuine medical needs have timely access to appropriate treatments. Source: PTI