The World Health Organization (WHO) today published an analysis of how antibiotics are used globally. The report is based on 2022 data from the Global Antimicrobial Resistance (AMR) and Use Surveillance System (GLASS) dashboard and the WHO Access, Watch, Reserve (AWaRe) system that classifies antibiotics into three categories:
- Access antibiotics are often recommended as first- or second-choice treatments for common infections because of their safety, low cost, narrow spectrum and low likelihood of causing AMR. At the 2024 UN General Assembly High-Level Meeting on AMR , countries committed to ensuring that Access antibiotics would account for at least 70% of global antibiotic use by 2030.
- Watch antibiotics have a broader spectrum and are typically more expensive. They are generally recommended as first-choice options for patients with more severe infections.
- Reserve antibiotics are last-resort antibiotics used to treat multidrug-resistant infections.
Since GLASS started to cover antimicrobial use in 2020, 90 countries, territories and areas (CTAs) were enrolled by December 2023, of which 74 have reported national data. However, global participation remains below 50%, with gaps in data from non-European and lower-income countries.
In 2022, overall, 18 out of every 1000 people received an antibiotic every day – based on a median of 18.3 defined daily doses per 1000 inhabitants per day (DID). However, antibiotic use varies by a factor of 10 between the highest-using and the lowest-using CTA. While these variations need to be better understood, they suggest patterns of both overuse and low access to antibiotics.
Use of Watch antibiotics remains relatively high in many settings and therefore, only one in three CTAs is meeting the UN target calling for 70% of antibiotics to be from the Access category. Watch antibiotics contribute disproportionately to AMR and more must be done to avoid their unnecessary use when no antibiotics are needed or Access antibiotics would suffice.
Lastly, some low- and middle-income CTAs reported little or no use of Reserve antibiotics, which are needed to treat infections caused by the most drug-resistant bacteria.
Immediate priorities
The main findings of the report have immediate implications for policy.
First, WHO will continue to assist countries in establishing sustainable surveillance systems for collecting high quality antibiotic use data. The WHO Academy will provide an online course to improve measurement, understanding and use of data on antibiotic use to strengthen capacity in CTAs.
Second, countries need to implement stewardship policies so that prescribers default to using Access instead of Watch antibiotics whenever possible and avoid unnecessary use of antibiotics in the first place. WHO will work closely with partners, including the World Medical Association, the international organization representing physicians, who have a crucial role in taking forward this report's next steps, particularly those relating to responsible prescribing.
Third, countries need to ensure access to all essential antibiotics, including those in the Reserve category. WHO is working with partners, such as the Global Antibiotic Research and Development Partnership, to develop a framework to improve availability of essential antibiotics for countries with limited resources.
AMR occurs when bacteria, viruses, fungi and parasites do not respond to medicines, leading to infections becoming difficult or impossible to treat, increasing the risk of disease spread, severe illness and death. AMR risks reversing many advances in modern medicine. Overuse and misuse of antibiotics and other antimicrobials are major drivers of AMR yet inadequate access to essential medicines remains a problem in many resource-limited settings.
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