Goal

The aim is to define optimal levels of Access, Watch, and Reserve (AWaRe) antibiotic use for 186 countries based on population health needs by analysing data on infection burden, comorbidities, demographics, healthcare infrastructure, and antibiotic resistance patterns, the project estimates country-specific antibiotic use in DDD/1000 inhabitants/day (DID).

Lead

Aislinn Cook – City St George’s, University of London

What we did

Using data from the Global Burden of Disease (GBD), Global Research on Antimicrobial Resistance (GRAM), World Bank, and IQVIA, we group 186 countries into “peer” clusters to enable benchmarking and estimation of optimal antibiotic use by AWaRe category based on infection burden and AWaRe Book guidance.

Key learnings

The findings indicate that

• 77% of optimal global antibiotic use should come from Access antibiotics, supporting the UNGA 70% target
• 80% of global Watch and Reserve needs are in low and middle income countries
• Many countries are using more antibiotics than estimated to be optimal
• Most countries overuse Watch antibiotics, while many also underuse Access and Reserve antibiotics, highlighting both inappropriate use and gaps in access

This framework can help move the conversation beyond measuring antibiotic consumption alone. By linking antibiotic use with public health need, it provides countries with a practical approach to setting national AWaRe targets and designing policies that both reduce inappropriate use and improve access to essential antibiotics.

Outputs

Benchmarking AWaRe: estimating optimal levels of AWaRe antibiotic use in 186 countries, territories and areas based on clinical infection and resistance burden

Funder

The Wellcome Trust