Antibiotic resistance is often framed as a problem of overuse, but a sweeping new global study finds the picture is more lopsided than that: many countries are prescribing far more powerful antibiotics than they need, even as millions of people elsewhere go without the drugs they do need.

Researchers led by the University of Oxford, together with City St George’s, University of London, built what they describe as the first global framework for estimating how many antibiotics of each type a country actually needs, based on its burden of infection and resistance. The World Health Organization sorts antibiotics into three tiers: Access antibiotics for common infections with low resistance risk, Watch antibiotics that carry higher resistance and safety concerns, and Reserve antibiotics held back as a last resort for multidrug-resistant infections. The team analyzed data spanning 186 countries, territories, and areas — covering 99.8% of the world’s population — grouping them into peer groups based on infection burden, resistance patterns, socioeconomic factors, and healthcare access, then using the lowest-use, lowest-death countries within each group as benchmarks.

By that measure, the world needed roughly 43 billion days of antibiotic treatment in 2019 — about one course per person per year — with roughly 77% of that ideally coming from the Access category, in line with a United Nations goal of reaching at least 70% Access use by 2030. More than 80% of the estimated global need for Watch and Reserve antibiotics falls on lower-income countries, even though it is higher-income countries that currently consume the most of both. Comparing the model’s estimates against real-world data from 67 countries, the researchers found that 72% used more antibiotics overall than needed, 99% over-prescribed Watch antibiotics, and 60% still used antibiotics the WHO says should no longer be prescribed at all — while 42% used fewer Access antibiotics than optimal and 52% failed to use enough Reserve antibiotics, potentially leaving patients with life-threatening resistant infections without the treatment they need.

The study’s authors recommend cutting back unnecessary Watch prescribing, expanding access to Access-category antibiotics where they’re under-used, and shoring up Reserve antibiotic availability where it’s lacking, alongside better monitoring and nationally tailored targets grounded in local data. Lead author Aislinn Cook, of City St George’s and the University of Oxford, said the findings show the world faces a double challenge — misuse in some places, unmet need in others — while coauthor Koen Pouwels of Oxford said global targets like the UN’s 70% Access goal are an important starting point for addressing it. The study, published in The Lancet Public Health, was funded by the Wellcome Trust.

Journal: The Lancet Public Health
Article Title: 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
Publication Date: July 21, 2026

Source: EurekAlert