Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates
Introduction Inappropriate antibiotic use is a major driver of antimicrobial resistance. However, the scope of literature and its prevalence across world regions remain largely unknown, as do the most common indicators and study designs used. In this study, we summarised the current literature on in...
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BMJ Publishing Group
2025-05-01
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| author | Ramanan Laxminarayan Sumanth Gandra Ranya Mulchandani Eili Klein Arindam Nandi Katie Tiseo Thomas Van Boeckel |
| author_facet | Ramanan Laxminarayan Sumanth Gandra Ranya Mulchandani Eili Klein Arindam Nandi Katie Tiseo Thomas Van Boeckel |
| author_sort | Ramanan Laxminarayan |
| collection | DOAJ |
| description | Introduction Inappropriate antibiotic use is a major driver of antimicrobial resistance. However, the scope of literature and its prevalence across world regions remain largely unknown, as do the most common indicators and study designs used. In this study, we summarised the current literature on inappropriate use of antibiotics by world regions. We also provided the first global estimates of the overall amount of antibiotics that are potentially used inappropriately each year.Methods We considered both patient and provider-mediated inappropriate antibiotic use. We reviewed 412 studies published between 2000 and 2021 and used beta regression and marginal contrasts to compare prevalence of inappropriate use by study design, indicator, world region, and national income level. Country-level sales of antibiotics from 2022 were combined with inappropriate antibiotic use estimates derived from two study designs (clinical audits and patient interviews) and one indicator (lack of indication) to estimate the amount of antibiotics inappropriately used globally.Results Clinical audits (50.1%, 208/412) and ‘non-prescription’ use (37.1%, 153/412) were the most common study design and indicator, respectively, used to estimate inappropriate antibiotic use. Inappropriate antibiotic use prevalence was ~6% higher in low-income and middle-income than in high-income countries. However, this difference disappeared after accounting for a proxy of access to care: physicians per capita. Globally, based on clinical audits, patient interviews and lack of indication, the estimated proportion of inappropriate antibiotic use was 29.5%, 36.5% and 30.8%, respectively, with an average of ~30% (~13 000 000 kg) the equivalent of the annual antibiotic consumption in China.Conclusions Inappropriate antibiotic use is highly prevalent across all countries regardless of national income level, with a third of global antibiotic consumption potentially due to unnecessary prescription (‘lack of indication’). Antibiotic stewardship efforts and defining internationally standardised indicators are needed to track progress in reducing the occurrence of inappropriate antibiotic use where necessary, as well as identifying gaps in access to care. |
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| issn | 2753-4294 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-e08c91eaac184ce88c8a8b30648f48d32025-08-20T02:38:28ZengBMJ Publishing GroupBMJ Public Health2753-42942025-05-013110.1136/bmjph-2024-002411Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimatesRamanan Laxminarayan0Sumanth Gandra1Ranya Mulchandani2Eili Klein3Arindam Nandi4Katie Tiseo5Thomas Van Boeckel66 One Health Trust India, Bengaluru, India5 Division of Infectious Diseases, Department of Medicine, Washington University, Saint Louis, Missouri, USA1 Health Geography and Policy Group, ETH Zurich, Zurich, Switzerland3 One Health Trust, Washington, District of Columbia, USA2 Population Council, New York, New York, USA1 Health Geography and Policy Group, ETH Zurich, Zurich, Switzerland1 Health Geography and Policy Group, ETH Zurich, Zurich, SwitzerlandIntroduction Inappropriate antibiotic use is a major driver of antimicrobial resistance. However, the scope of literature and its prevalence across world regions remain largely unknown, as do the most common indicators and study designs used. In this study, we summarised the current literature on inappropriate use of antibiotics by world regions. We also provided the first global estimates of the overall amount of antibiotics that are potentially used inappropriately each year.Methods We considered both patient and provider-mediated inappropriate antibiotic use. We reviewed 412 studies published between 2000 and 2021 and used beta regression and marginal contrasts to compare prevalence of inappropriate use by study design, indicator, world region, and national income level. Country-level sales of antibiotics from 2022 were combined with inappropriate antibiotic use estimates derived from two study designs (clinical audits and patient interviews) and one indicator (lack of indication) to estimate the amount of antibiotics inappropriately used globally.Results Clinical audits (50.1%, 208/412) and ‘non-prescription’ use (37.1%, 153/412) were the most common study design and indicator, respectively, used to estimate inappropriate antibiotic use. Inappropriate antibiotic use prevalence was ~6% higher in low-income and middle-income than in high-income countries. However, this difference disappeared after accounting for a proxy of access to care: physicians per capita. Globally, based on clinical audits, patient interviews and lack of indication, the estimated proportion of inappropriate antibiotic use was 29.5%, 36.5% and 30.8%, respectively, with an average of ~30% (~13 000 000 kg) the equivalent of the annual antibiotic consumption in China.Conclusions Inappropriate antibiotic use is highly prevalent across all countries regardless of national income level, with a third of global antibiotic consumption potentially due to unnecessary prescription (‘lack of indication’). Antibiotic stewardship efforts and defining internationally standardised indicators are needed to track progress in reducing the occurrence of inappropriate antibiotic use where necessary, as well as identifying gaps in access to care.https://bmjpublichealth.bmj.com/content/3/1/e002411.full |
| spellingShingle | Ramanan Laxminarayan Sumanth Gandra Ranya Mulchandani Eili Klein Arindam Nandi Katie Tiseo Thomas Van Boeckel Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates BMJ Public Health |
| title | Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates |
| title_full | Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates |
| title_fullStr | Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates |
| title_full_unstemmed | Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates |
| title_short | Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates |
| title_sort | global trends in inappropriate use of antibiotics 2000 2021 scoping review and prevalence estimates |
| url | https://bmjpublichealth.bmj.com/content/3/1/e002411.full |
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