Global antibiotic stewardship has long relied on broad targets, but a blunt percentage applied uniformly across vastly different disease environments may be more political than scientific. A framework published in The Lancet Public Health now offers the first burden-adjusted methodology for estimating what each country's antibiotic use should actually look like — and the results complicate the headline target adopted at the 2024 UN General Assembly.
The research team drew on three major datasets — the Global Burden of Disease Study 2021, the Global Research on Antimicrobial Resistance project, and World Bank sociodemographic data — to group 186 countries, territories, and areas into four peer clusters using latent class modeling. Within each cluster, benchmark nations were identified by their combination of low antibiotic consumption and low infection-related mortality, essentially representing efficient use. From those benchmarks, country-specific optimal defined daily doses (DDD) per 1,000 inhabitants per day were calculated across all three AWaRe tiers: Access antibiotics for common infections, Watch antibiotics for higher-risk situations, and Reserve antibiotics calibrated against each country's specific antimicrobial resistance burden.
The significance here is methodological as much as clinical. The UN's 70% Access target is a global aggregate, not a national prescription — and the Lancet framework reveals that optimal Access proportions legitimately vary by local infection profile, resistance prevalence, and healthcare capacity. A country with high burdens of drug-resistant gram-negative infections will rationally require a different Watch-to-Access ratio than one where pneumococcal pneumonia dominates. This analysis gives policymakers a defensible, epidemiologically grounded alternative to arbitrary thresholds. The primary limitation is that 2019 data serve as the baseline, predating COVID-19's profound disruption to both infection patterns and antibiotic prescribing globally. As a modeling study, it also cannot account for real-world supply constraints or formulary availability. Still, the framework represents a meaningful step from population-level targets toward individualized national stewardship benchmarks — an incremental but important refinement in global antimicrobial resistance governance.