A global study shows that almost all countries overuse antibiotics with a high potential to cause resistance
Most countries overuse antibiotics, particularly those with the greatest potential to cause resistance, according to a new study published in the journal The Lancet Public Health using data from 186 countries, including Spain. The study estimated optimal national levels of antibiotic use based on the World Health Organisation’s (WHO) AWaRe guidelines, which classify antibiotics into the ‘access’ group – first-line drugs, such as amoxicillin – the ‘caution’ group – more potent drugs with more restricted use – and the ‘reserve’ group – drugs of last resort, for resistant infections. Of the 67 regions with data on antibiotic use, 72 per cent used quantities exceeding those considered optimal, and 99 per cent overused antibiotics in the ‘caution’ group – those that contribute most to the development of resistance. High-income regions used fewer antibiotics than low- and middle-income regions.
2026 07 22 demasiados antibióticos Rafael Cantón EN
Rafael Cantón
Head of the Microbiology Department at the Ramón y Cajal University Hospital, member of the Ramón y Cajal Institute for Health Research (IRYCIS) and ESCMID Fellow.
Does the press release accurately reflect the study?
“The press release is accurate. It highlights the most significant findings, as the study contains a great deal of information regarding the use of antimicrobials in different countries and geographical areas, which can be found specifically in the appendices to the article. These findings can be used to formulate recommendations on the appropriate use of antimicrobials.”
Is the study of good quality? Are the conclusions supported by robust data?
"Methodologically, the study analyses data on antimicrobial use obtained from various databases in order to draw conclusions. Countries and geographical areas are classified according to the economic level established by the World Bank, and antimicrobials are classified according to the WHO classification (AWaRe Classification) into ‘access’ antibiotics, which should be the most commonly used (e.g. amoxicillin); ‘surveillance’ [‘caution’], which should be reserved for infections where the former may not be effective, and finally ‘reserve’ antibiotics, which include those that should be used as a last resort for infections caused by microorganisms resistant to the former. The study confirms the overuse of antibiotics, particularly in lower-income countries where antimicrobial resistance is high. Furthermore, this consumption does not, overall, comply with the recommendations established by the United Nations, reaffirming the target that 70 per cent should be in the ‘access’ category."
How does this study fit in with the existing evidence?
“There are no previous studies that estimate the optimal level of antimicrobial use according to the WHO’s AWaRe classification, based on countries’ economic status and levels of antimicrobial resistance.”
Are there any significant limitations to consider?
“The study may have some limitations regarding the different types of infection and antimicrobial requirements, as many countries have very few antibiotics from the ‘reserve’ group. Furthermore, not all of the countries included in the analysis have actual data on antibiotic use; consequently, a projection is made based on requirements.”
What are the implications for the real world?
“The specific data for each geographical area and country can be used to establish policies to improve the use of antimicrobials in each of them.”
Aislinn Cook et al.
- Research article
- Peer reviewed
- Observational study
- Modelling
