Fighting Antibiotic Resistance Starts With Smarter National Policies

A global analysis suggests country-specific antibiotic use targets could better balance access, appropriate prescribing, and resistance control.

A new analysis published in The Lancet Public Health suggests that measuring antibiotic use by a single global target may overlook important differences in disease burden and antibiotic resistance across countries. Instead, the authors developed a framework to estimate how much of each type of antibiotic countries may optimally need based on their own infection patterns, resistance burden, and population characteristics (1^✔ ✔Trusted Source
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

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The analysis estimated that about 43 billion defined daily doses of antibiotics were needed globally in 2019. Around 77% of this optimal use was estimated to come from WHO’s Access, Watch, Reserve (AWaRe) Access group, supporting the global goal that at least 70% of antibiotic use should be Access antibiotics. Among 67 countries with available antibiotic use data, 72% used more antibiotics overall than the estimated optimal level. Nearly all of them used more Watch antibiotics than expected, while many used lower-than-estimated amounts of Access and Reserve antibiotics. Lower-income countries were estimated to require a greater share of Watch and Reserve antibiotics because of their higher infectious disease and antimicrobial resistance burden.

Why the AWaRe Antibiotic System Matters

The WHO AWaRe system classifies antibiotics into three groups:

• Access: First or second choice medicines for common infections with lower resistance potential
• Watch: Antibiotics that should be reserved for specific infections because they carry a higher risk of promoting resistance
• Reserve: Last-resort medicines for difficult-to-treat, multidrug-resistant infections

The new framework estimates the amount of each group that countries may need while considering local health conditions rather than relying on a single percentage target.

How Countries Differ in Antibiotic Needs

The analysis grouped 186 countries, territories, and areas according to factors such as income, infection burden, resistance levels, demographics, and health-care access.

It found that:

• Countries with greater infectious disease burden may legitimately require more antibiotics overall.
• Lower-income settings may also need relatively more Watch and Reserve antibiotics because resistant infections are more common.
• High-income countries often exceeded the estimated optimal total antibiotic use despite having lower clinical need.

Someone visiting a clinic with a routine throat infection may only need an Access antibiotic, while a patient with a serious drug-resistant infection in a hospital may require a Reserve medicine. The findings highlight why both situations should be reflected in national antibiotic planning.

Balancing Access With Antibiotic Stewardship

The analysis also identified widespread overuse of Watch antibiotics alongside potential gaps in access to essential antibiotics in some settings.

As stated by lead author Aislinn Cook, “Benchmarking is an established quality-improvement tool in health care and could similarly be used to monitor progress towards national antibiotic use targets, inform procurement strategies, and enhance shared learning of policy interventions and outcomes.”

A country meeting the 70% Access target could still be using more antibiotics than clinically needed overall. Conversely, another country may require greater access to specific antibiotics because of a heavier burden of resistant infections.

What These Findings Could Mean

Rather than viewing antibiotic use as simply reducing prescriptions, this work points toward a more tailored approach that considers the health needs of individual countries. The implications may extend beyond antibiotic stewardship by helping governments plan procurement, improve access where shortages exist, and identify areas where unnecessary prescribing can be reduced.

As countries continue refining national antibiotic policies, comparing actual use with estimated clinical need may offer a more practical way to balance access with responsible antibiotic use.

Every appropriate antibiotic prescription helps protect both individual patients and the effectiveness of these medicines for others. Supporting responsible antibiotic use begins with ensuring that the right medicine reaches the right person at the right time.

Reference:

1. 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 – (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(26)00103-9/fulltext)

Source-Medindia