In human medicine

Antibiotic overuse in humans

Antibiotic consumption for human health has significantly increased over the past few decades, with a notable rise of 46% between 2000 and 2018. This increased use, both in hospitals and communities, has been linked to the emergence of resistant strains, creating a need for broader-spectrum antibiotics, which further accelerates the development of resistance. Worryingly, it is estimated that approximately 50% of all antibiotic use is inappropriate. This includes instances such as prescribing antibiotics when they are not needed, using unnecessarily broad-spectrum antibiotics, or administering incorrect dosages, treatment durations, or formulations. There is a substantial variation in antibiotic consumption between countries, driven by factors such as socioeconomic conditions, cultural differences, financial incentives, fear of lawsuits, and the lack of treatment guidelines.

Patient expectations and over-prescribing providers

Antibiotics are widely used medicines for treating bacterial infections. Most of us have taken antibiotics at some point—and in many cases, they may have saved lives. However, a major issue is that antibiotics are often used when they are not needed, or when their effectiveness is limited. One contributing factor is that antibiotics are commonly seen as “miracle drugs” that are safe and capable of curing most infections. Additionally, some antibiotics are so readily available that they are taken for granted. Both patients and prescribers often have high expectations of antibiotic treatment. This is especially true for conditions like upper respiratory tract infections, where spontaneous recovery is very likely and the benefit of antibiotics is minimal or nonexistent. Even when an infection is caused by bacteria, antibiotics may sometimes have little or no effect. Patient pressure to receive antibiotics, along with inappropriate prescribing by healthcare providers, contributes to the unnecessary overuse of antibiotics. Providers may also prescribe antibiotics unnecessarily for other reasons, such as fear of misdiagnosing a patient, lack of knowledge, fear of legal consequences, or financial incentives.

Lack of diagnostics tools

Another contributing factor to the unnecessary use of antibiotics is the lack of rapid and accurate diagnostic tools. It can take several days from when a patient provides a sample to when a diagnosis is confirmed and the pathogen’s resistance profile is determined. In the absence of a clear diagnosis, healthcare providers may prescribe antibiotics “just in case.” This often leads to the use of broad-spectrum antibiotics when the susceptibility of the bacteria is unknown. Improved diagnostic tools would support healthcare professionals in prescribing more appropriate treatments and help avoid unnecessary use of broad-spectrum antibiotics. Furthermore, when a test confirms that an infection is not bacterial, patients are more likely to accept that antibiotics are not needed. One major challenge is developing diagnostic tools that are affordable and feasible to use in low-resource settings, where advanced laboratory equipment may be lacking. If a test is too costly or technically complex, it is less likely to be implemented in practice.

Over the counter sales of antibiotics

Non-prescription use has been reported to account for 19–100% of total antibiotic consumption outside of Europe and North America, and is particularly common in many low- and middle-income countries. This widespread availability contributes to inappropriate use, as it allows individuals to self-medicate without proper medical consultation. Consequently, antibiotics may be taken when they are not necessary, or the wrong type, dosage, or duration may be used. One solution to this problem is to regulate antibiotics as prescription-only medicines, which is already standard practice in most high-income countries. However, in low- and middle-income countries, this approach might result in reduced access to antibiotics due to the limited availability of healthcare professionals authorized to issue prescriptions.

For more information on access and regulating antibiotic use, see:
POLICY: Implement the plan – Rational use of antibiotics and Access.