Access to Reserve Antibiotics in Latin America and the Caribbean: Situation, Challenges, and Future Directions.

Access to Reserve antibiotics, which are defined by the World Health Organization's AWaRe (Access, Watch, Reserve) classification framework as last-resort treatments for multidrug-resistant infections, remains poorly documented in Latin America and the Caribbean despite evidence of increasing antimicrobial resistance in the region, with associated and attributable mortality projected to rise. We examined the landscape of Reserve antibiotic access across Latin America and the Caribbean, identifying the systematic barriers that prevent patients from receiving appropriate treatment. We found that multiple interconnected obstacles-spanning regulatory approval, manufacturer participation, formulary inclusion, procurement systems, and health technology assessment capacity-create compounding delays and gaps in access. The existing barriers also perpetuate inequities where public hospitals face significantly greater constraints to acquire essential antibiotics compared to private facilities. We identified encouraging developments to address these gaps, including emerging regional manufacturing capacity and existing collaborative frameworks. Still, collecting systematic data on access patterns remains insufficient, limiting evidence-based policy responses. Importantly, addressing Reserve antibiotic access requires recognizing that appropriate use encompasses both stewardship and availability of effective treatments when needed. We propose that improving access requires coordinated interventions across five domains: regulatory pathways, production capacity, essential medicines lists, procurement mechanisms, and dedicated national programs. By documenting regional realities and examining practical solutions already implemented in Latin America and the Caribbean, this review aims to inform future evidence generation efforts and policy dialogue toward reducing preventable mortality from treatable resistant infections.