ArticlePLOS global public health2025
Association between national action and trends in antibiotic resistance: an analysis of 73 countries from 2000 to 2023.
Article in PLOS global public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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Who cites it
4 citing papers in PubMed.
- Antibiotic prescriptions in Lombardy Region according to WHO AWaRe classification: trend from 2000 to 2024.Scientific reports · 2026Article
- The Implementation of Antimicrobial Consumption Surveillance and Stewardship in Human Healthcare in Post-Soviet States: A Systematic Review.Antibiotics (Basel, Switzerland) · 2025Review
- Observational
- Antibiotic stewardship: what for?Frontiers in antibiotics · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The world's governments have agreed on actions to address the challenge of antibiotic resistance. This raises the question of what level of national action is associated with improved outcomes, including both slower growth and lower levels of antibiotic resistance. Answering this question is challenged by variation in data availability and quality as well as disruptive events such as the COVID-19 pandemic. We investigate the association between level of national action and temporal trends in multiple indicators related to health system capacity, antibiotic use (ABU), absolute rates of resistance (ABR) and a Drug Resistance Index (DRI). Using the Global Database for Tracking Antimicrobial Resistance (TrACSS) to construct an index of national action, we apply cross-sectional regression across 73 countries to estimate the association between the level of action in 2016 and trends in national indicators (2000-2016). We find that national action is consistently associated with improved linear or categorical trends in all groups of indicators. Reductions are associated with a relatively high action index (range 0-4) for ABU (median 2.8, 25-75% quartile 2.6-3.3), ABR (3.0, 2.4-3.4), and DRI (3.5, 3.1-3.6). These associations are robust to the inclusion of other contextual factors related to socio-economic conditions, human population density, animal production and climate. Since 2016, a majority of both Low- and Middle-Income Countries (LMICs) and High-Income Countries (HICs) report increased action on repeated questions, while one third of countries report reduced action. The main limitations in interpretation are heterogeneity in data availability and in when actions have been implemented. Our findings highlight the importance of national action to address the domestic situation related to antibiotic resistance and indicate the value of both incremental changes in reducing adversity of outcomes and the need for high levels of action in delivering reduced levels of resistance.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.