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A major international study of antibiotic use has developed the first global framework to estimate how many and which type of antibiotics each country needs to treat infections.
Publishing their findings in The Lancet Public Health on 22 July 2026, study authors said that the benchmarking framework “offers a data-driven method to estimate antibiotic need and to assist CTAs [countries, territories and areas] in evaluating their levels of antibiotic use in comparison with optimal patterns”.
The Independent Panel for Evidence for Action on AMR will evaluate the targets, policies and regulations that could guide CTAs towards improved antibiotic use and access, the study authors added.
Antibiotics are grouped by the World Health Organization (WHO) into three categories, known as ‘AWaRe’: ‘access’ antibiotics which are used for most common infections and have a lower resistance risk; ‘watch’ antibiotics, which have a broader spectrum and are used for specific infections and come with higher safety and resistance concerns; and ‘reserve’ antibiotics which are last resort antibiotics used to treat multi-drug-resistant infections.
In 2024, the United Nations agreed that at least 70% of antibiotic use worldwide should come from the ‘access’ group by 2030. However, no method previously existed to determine the right balance of antibiotics for any individual country.
To address this, researchers led by City St George’s, University of London and the University of Oxford analysed global data from 186 CTAs and grouped countries into ‘peer groups’ based on similar infection burdens, resistance patterns, socioeconomic characteristics and healthcare access.
Within each group, countries with the lowest antibiotic use and the fewest infection-related deaths were used as benchmarks to determine what optimal antibiotic use should look like for similar countries.
They then estimated optimal levels of ‘access’, ‘watch’ and ‘reserve’ antibiotics required in each setting based on infection and resistance burdens. The UK was placed into cluster 4, among the highest income CTAs.
Although higher-income countries use the most ‘watch’ and ‘reserve’ antibiotics, researchers estimated that more than 80% of the world’s optimal need for these medicines was in lower-income countries, where infectious disease and antimicrobial resistance (AMR) burdens are highest.
The researchers then compared estimates with real-world antibiotic use data from 67 countries where this data was available. Nearly three-quarters (72%, n=48) of countries analysed were using more antibiotics in total than needed, while almost every country (99%, n=66) prescribed too many ‘watch’ antibiotics, which contribute the most to antibiotic resistance.
In addition, the researchers observed that six in ten (60%, n=40) countries that were analysed were still using antibiotics that the WHO considers should no longer be prescribed.
Meanwhile, more than one-third (42%, n=28) of the countries were using fewer ‘access’ antibiotics than estimated optimal levels, while more than half (54%, n=36) were not using enough ‘reserve’ antibiotics than estimated to be needed, the researchers noted.
Overall, they highlighted that if estimated optimal use levels were met, only 14.1% of total global antibiotic need was expected to be from cluster 4 CTAs.
The results of the Wellcome Trust-funded study indicated that many countries could improve antibiotic use by reducing unnecessary ‘watch’ antibiotic prescribing while increasing access to essential ‘access’ antibiotics and ensuring availability of ‘reserve’ antibiotics for patients with highly resistant infections.
Lead author Aislinn Cook, senior research fellow in infectious diseases epidemiology at City St George’s, University of London, said: “Our findings show the world faces a double challenge — while some antibiotics are being overused, millions of people may still lack access to the medicines they need to treat their infections.
“We have developed the first practical way for countries to estimate how much of each type of antibiotic their populations need based on infection burden and antibiotic resistance. This framework can help move the conversation beyond measuring antibiotic consumption to matching antibiotic use with public health need. This can support countries to develop more targeted policies to reduce overuse while ensuring sustainable access to effective antibiotics.”
Commenting on the study, Amira Guirguis, chief scientist of the Royal College of Pharmacy, said: “One of the most important messages from this study is that good antimicrobial stewardship is not simply about using fewer antibiotics. It is about making sure patients receive the right antibiotic when they need one, while avoiding unnecessary or inappropriate use that contributes to AMR.
“There isn’t a one-size-fits-all solution. Efforts to improve antibiotic use must reflect local clinical need, resistance patterns and health system circumstances, while remaining grounded in evidence-based prescribing. That means continuing to prescribe, supply and support the safe use of antibiotics in line with clinical guidance, while helping patients understand when antibiotics will and won’t benefit them.”
