ArticleBMJ global health2025
Substandard and falsified antibiotics are associated with antimicrobial resistance: a retrospective country-level analysis.
Article in BMJ global 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.
- Medication Safety in India and Southeast Asia: A SWOT Analysis of Policies and Practices.Pharmaceutical medicine · 2026Review
- Substandard and Falsified Antibiotics Seized in Belgium: Quality Control Analysis Reveals High Prevalence of WHO Watch List Molecules and Bioavailability Non-Compliance.Antibiotics (Basel, Switzerland) · 2026Article
- Drug recall, its frequencies and conclusion: a retrospective secondary analysis involving 2-year publicly available data from Nepal.Therapeutic advances in drug safety · 2025Article
- Perceptions and practices on substandard and falsified medicines in humans and animals in Wakiso district, Uganda: A qualitative study.PloS one · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveSubstandard and falsified (SF) medicines pose a significant public health concern due to their elusive nature and potentially dire consequences, including the exacerbation of antimicrobial resistance (AMR). This study aims to quantitatively assess the relationship between the prevalence of SF antibiotics and AMR.
methodsWe combine the Infectious Diseases Data Observatory database (1962-2019), with Global Bacterial Antimicrobial Resistance Burden Estimates (2019) to investigate whether the prevalence of SF antibiotics is positively associated with AMR. Using a quasi-binomial regression, we analyse 257 unique observations across 63 countries and 7 antibiotic classes between 1992 and 2019. We adjust the model for socioeconomic, environmental, health-related, governance and livestock production factors.
findingsWe find that the prevalence of SF antibiotics is positively associated with AMR, after controlling for Gross Domestic Product per capita, population density, particulate matter 2.5, cardiovascular death rate, human antibiotic consumption, regulatory quality, livestock production. The prevalence of SF antibiotics is also positively associated with deaths per 100 000 people attributable to or associated with AMR. This is robust to adding more covariates and country fixed effects as well as dropping countries with a limited number of observations.
conclusionAMR ranks among the top global health threats, presenting a multifaceted challenge affecting humans, animals and environment. This study sheds light on the possible relationship between SF antibiotics and AMR. While the prevalence of SF antibiotics appears to be associated with AMR, further research and more representative data are needed to determine the extent to which this association could be explained by a direct causal relationship.
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