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Toolbox  –  Measure

Appropriate use of antibiotics

It is important to understand if antibiotics are used appropriately for the right infections and according to treatment guidelines. This section provides resources to help measure appropriateness of antibiotic use in human and animal settings.

Data on the inappropriate use of antibiotics may provide an idea of the magnitude of the problem and help to inform policy decisions and in planning an intervention. For information on how to set up initiatives promoting the rational use of antibiotics in a systematic way, and interventions to use in such efforts, see the RATIONAL USE focus area.

Strictly speaking, appropriateness of antibiotic use is a different issue from antibiotic consumption although they are closely linked. Many tools are similar, but measuring appropriateness requires additional data to be collected, such as indication.

The World Health Organisation (WHO) estimates that 50% of medicines used in human medicine are prescribed, dispensed or sold inappropriately. In addition, the United States Center for Disease Control and Prevention estimates that 20-50% of antibiotics prescribed in acute care hospitals in the United States are either inappropriate or not necessary. The situation may be even worse in low-and middle-income countries where resources for diagnosis and surveillance are limited.

In many parts of the world, antibiotics are given routinely to livestock in order to promote growth or to prevent bacterial diseases. It is also common that antibiotics are available without a prescription.

Read more about the consequences of antibiotic use in UNDERSTAND – How did we end up here – Use and inappropriate use.

What is considered appropriate may vary from different geographical locations and different prescribing and clinical guidelines.


Benchmarking, including setting targets, is often used to compare consumption between regions, farms or hospitals. It can also be used as one tool to work towards increased appropriateness of antibiotic use. Two populations (communities or farms) that should be comparable with regard to prevalence of infections and patient demographics, should have similar levels of antibiotic consumption. Targets to be reached or limits of use should be evidence based.

Further reading

Centers for Disease Control and Prevention - CDC. Core Elements - Implementation Resources - Get Smart for Healthcare [Internet]. [cited 2015 Apr 23]. Available from:
World Health Organization - WHO. Rational use of medicines [Internet]. WHO. [cited 2015 Apr 27]. Available from: