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Poor antibiotic management squanders life-saving drugs in two connected ways: unnecessary or inappropriate use speeds the rise of resistance, while shortages and weak access can leave people without effective treatment or push clinicians toward less suitable alternatives. The answer is not simply to use fewer antibiotics. Health systems must preserve access to effective treatment while making sure each antibiotic is used appropriately.
What is being lost—and why it matters
Antimicrobial resistance (AMR) occurs when microorganisms no longer respond to medicines. It includes resistance in bacteria, viruses, fungi and parasites; antibiotic resistance is one important part of the wider problem. When bacteria resist antibiotics, infections can become harder or sometimes impossible to treat.
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The World Health Organization’s fact sheet, updated 16 July 2026, reports that bacterial AMR was associated with more than 4.7 million deaths worldwide in 2021. “Associated with” does not mean every one of those deaths was directly caused by resistance. The same fact sheet estimates that about one in six laboratory-confirmed bacterial infections worldwide was resistant to antibiotics in 2023. These figures describe different measures and years, not a count of deaths or infections in 2026.
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How mismanagement makes antibiotics less useful
Inappropriate use selects for resistance
When antibiotics are used unnecessarily, or the wrong antibiotic is used, susceptible bacteria are more likely to be killed while resistant ones survive and multiply. Resistant organisms can then spread. WHO identifies misuse and overuse as major drivers of AMR, including taking antibiotics when they are not needed or taking the wrong type. This is a population-level process: resistance is not simply the fault of individual patients.
Antibiotics do not treat every infection. Uncertain diagnoses, limited laboratory capacity, weak prescribing oversight, non-prescription sales, and poor awareness can all contribute to inappropriate use. In the other direction, a patient who cannot obtain an appropriate medicine may go untreated or receive an unsuitable substitute. Stewardship has to address both problems.
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Shortages can distort treatment choices
A reliable supply of quality-assured first-line antibiotics matters to stewardship. In a 2023 commentary republished by Gavi, Manica Balasegaram, executive director of the Global Antibiotic Research and Development Partnership, argued that shortages of first-line antibiotics can lead to greater use of specialized or reserve medicines. This is an expert account of a plausible mechanism, not a quantified estimate of how often shortages cause resistance worldwide. The scale of shortages is difficult to measure precisely.
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Weak prevention means more need for treatment
Inadequate infection prevention and control, poor water, sanitation and hygiene, and limited access to vaccines can increase infections and transmission. More infections can mean more antibiotic treatment, while poor prevention can allow resistant organisms to spread. WHO also identifies limited access to diagnostics and medicines, weak awareness and enforcement, and antibiotic use in animals among factors that contribute to AMR.
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What antibiotic stewardship means
Antibiotic stewardship is coordinated work to ensure patients receive effective antibiotics when appropriate, while avoiding unnecessary or unsuitable use. It is not a rule to withhold treatment, a target to reduce all use regardless of need, or a consumer method for choosing a drug. The right clinical choice depends on diagnosis and individual circumstances, so treatment decisions belong with qualified health professionals.
WHO’s AWaRe framework groups antibiotics as Access, Watch and Reserve to help health systems monitor and guide use. Access antibiotics are recommended first-choice treatments for many common infections. Watch antibiotics generally require closer attention to their use, while Reserve antibiotics are kept for selected situations where other options may not be suitable. The categories support policy and surveillance; patients should not use them to select or request a particular medicine.
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WHO’s 2026 fact sheet reports that Access antibiotics accounted for 53% of global human antibiotic use in 2022, while about 45% was Watch use. Watch use exceeded 70% in nearly one-third of countries. WHO’s global target is for at least 70% of antibiotic use to come from the Access group by 2030. These are measures and a target for health systems, not instructions for an individual prescription.
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Why the system matters: a regional illustration
WHO’s Eastern Mediterranean Regional Committee paper EM/RC69/7 illustrates how prescribing patterns and regulation can differ by place. In regional data reported for 2019, Access, Watch and Reserve antibiotics made up 34%, 61% and 5%, respectively, of reported prescribed antimicrobial use. The report also said that, at the time it described, five countries enforced prescription-only antimicrobial sales and two had adopted AWaRe classification in national essential medicines lists.
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Those findings are historical and specific to the WHO Eastern Mediterranean Region; they are not a current count for that region or a proxy for the rest of the world. They show why stewardship cannot be reduced to telling patients to behave differently: prescribing practice, access, regulation and monitoring all shape what medicines are used.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What a stronger response needs
WHO’s 2026 fact sheet and the National Academies’ 2020 workshop proceedings point to a connected package of measures. No single intervention has a universal ranking: results depend on local disease patterns, resources, supply reliability and implementation.
| Area | How it helps | What implementation requires |
|---|---|---|
| Appropriate prescribing and regulation | Reduces unnecessary use and helps align treatment with diagnosis and guidance. | Clear prescribing rules, effective oversight, professional education and responsible enforcement. |
| Diagnostics, laboratories and surveillance | Helps identify infections and resistance patterns, supporting more informed treatment and public-health action. | Accessible, adequately resourced laboratory capacity and systems that collect and use reliable data. |
| Infection prevention, water and sanitation, and vaccination | Prevents some infections and limits transmission, reducing avoidable demand for antibiotics. | Infection-control practice and investment in public-health infrastructure. |
| Equitable access and dependable supply | Helps patients obtain appropriate treatment and reduces pressure to substitute less suitable medicines when stocks fail. | Reliable, quality-assured supply chains, affordability and coordinated procurement. |
| Safe waste management and One Health action | Addresses environmental pathways and antibiotic use beyond human clinical care. | Coordination across human health, animal health and environmental management. |
| Research, development and governance | Supports new tools and medicines while coordinating action across sectors. | Sustained investment, shared accountability and coordination rather than siloed policy. |
The National Academies’ 2020 proceedings describe the WHO Global Action Plan pillars as awareness and education; knowledge and surveillance; infection prevention and control; optimized antimicrobial use; and research and development. They also discuss obstacles such as weak stewardship and regulation, unreliable supply chains, affordability and access barriers, siloed governance and under-resourced laboratories. These proceedings provide systems context, not a current scorecard of national performance.
Innovation is part of the response, but it cannot replace stewardship or prevention. WHO’s 16 July 2026 fact sheet says the world faces an antimicrobial research and development crisis, with few new medicines in the pipeline. New treatments can help, but they can also lose effectiveness if their use and supply are poorly managed.
What individuals can do
- Ask a qualified health professional whether an antibiotic is appropriate for the infection being assessed; antibiotics are not suitable for every infection.
- Do not self-prescribe or use leftover antibiotics. Follow the treatment instructions given by your health professional rather than changing treatment on your own.
- Seek professional advice about access or supply problems instead of substituting another medicine without guidance.
These are general stewardship principles, not individual treatment or dosage advice. A health professional can assess the particular infection and circumstances.
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