Global trends in inappropriate use of antibiotics, 2000–2021: scoping review and prevalence estimates

作者：Ranya Mulchandani, Katie Tiseo, Arindam Nandi, Eili Klein, Sumanth Gandra, Ramanan Laxminarayan, Thomas P. Van Boeckel · 发表于：BMJ Public Health · 年份：2025 · DOI：10.1136/bmjph-2024-002411 · 被引用次数：61 · 研究领域：Antibiotic Use and Resistance、Pharmaceutical and Antibiotic Environmental Impacts、Pharmaceutical Quality and Counterfeiting

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. Globall...