{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T16:07:05Z","timestamp":1794586025842,"version":"4.9.1"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"unspecified","delay-in-days":146,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["874850"],"award-info":[{"award-number":["874850"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-055356"],"award-info":[{"award-number":["INV-055356"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["CCF1918628"],"award-info":[{"award-number":["CCF1918628"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The Swiss National Science Foundation Eccellenza Fellowship","award":["181248"],"award-info":[{"award-number":["181248"]}],"id":[{"id":"https:\/\/ror.org\/00yjd3n13","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Branco Weiss Foundation","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,4,10]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Inappropriate antibiotic use is a major driver of antimicrobial resistance. However, the scope of literature and its prevalence across world regions remain largely unknown, as do the most common indicators and study designs used. In this study, we summarised the current literature on inappropriate use of antibiotics by world regions. We also provided the first global estimates of the overall amount of antibiotics that are potentially used inappropriately each year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We considered both patient and provider-mediated inappropriate antibiotic use. We reviewed 412 studies published between 2000 and 2021 and used beta regression and marginal contrasts to compare prevalence of inappropriate use by study design, indicator, world region, and national income level. Country-level sales of antibiotics from 2022 were combined with inappropriate antibiotic use estimates derived from two study designs (clinical audits and patient interviews) and one indicator (lack of indication) to estimate the amount of antibiotics inappropriately used globally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical audits (50.1%, 208\/412) and \u2018non-prescription\u2019 use (37.1%, 153\/412) were the most common study design and indicator, respectively, used to estimate inappropriate antibiotic use. Inappropriate antibiotic use prevalence was ~6% higher in low-income and middle-income than in high-income countries. However, this difference disappeared after accounting for a proxy of access to care: physicians per capita. Globally, based on clinical audits, patient interviews and lack of indication, the estimated proportion of inappropriate antibiotic use was 29.5%, 36.5% and 30.8%, respectively, with an average of ~30% (~13 000 000\u2009kg) the equivalent of the annual antibiotic consumption in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inappropriate antibiotic use is highly prevalent across all countries regardless of national income level, with a third of global antibiotic consumption potentially due to unnecessary prescription (\u2018lack of indication\u2019). Antibiotic stewardship efforts and defining internationally standardised indicators are needed to track progress in reducing the occurrence of inappropriate antibiotic use where necessary, as well as identifying gaps in access to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002411","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T23:20:25Z","timestamp":1748388025000},"page":"e002411","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":77,"title":["Global trends in inappropriate use of antibiotics, 2000\u20132021: scoping review and prevalence estimates"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5157-1060","authenticated-orcid":false,"given":"Ranya","family":"Mulchandani","sequence":"first","affiliation":[{"name":"Health Geography and Policy Group, ETH Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3652-6859","authenticated-orcid":false,"given":"Katie","family":"Tiseo","sequence":"additional","affiliation":[{"name":"Health Geography and Policy Group, ETH Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arindam","family":"Nandi","sequence":"additional","affiliation":[{"name":"Population Council, New York, New York, USA"},{"name":"One Health Trust, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eili","family":"Klein","sequence":"additional","affiliation":[{"name":"One Health Trust, Washington, District of Columbia, USA"},{"name":"Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumanth","family":"Gandra","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramanan","family":"Laxminarayan","sequence":"additional","affiliation":[{"name":"One Health Trust India, Bengaluru, India"},{"name":"Princeton University, Princeton, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-0952","authenticated-orcid":false,"given":"Thomas","family":"Van Boeckel","sequence":"additional","affiliation":[{"name":"Health Geography and Policy Group, ETH Zurich, Zurich, Switzerland"},{"name":"One Health Trust, Washington, District of Columbia, USA"},{"name":"One Health Institute, University of Zurich, Zurich, Switzerland"},{"name":"Spatial Ecology and Epidemiology Lab, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"2025083110223535000_3.1.e002411.1","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jiph.2019.03.017","article-title":"Antimicrobial overuse and misuse in the community in Greece and link to antimicrobial resistance using methicillin-resistant S. aureus as an example","volume":"12","author":"Karakonstantis","year":"2019","journal-title":"J Infect Public Health"},{"key":"2025083110223535000_3.1.e002411.2","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1007\/s10096-015-2437-3","article-title":"Systematic analysis of the relationship between antibiotic use and extended-spectrum beta-lactamase resistance in Enterobacteriaceae in a French hospital: a time series analysis","volume":"34","author":"Vibet","year":"2015","journal-title":"Eur J Clin Microbiol Infect 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A systematic review of knowledge, tension, and motivation among clinicians in low-, middle- and high-income countries","volume":"345","author":"Chan","year":"2024","journal-title":"Soc Sci Med"},{"key":"2025083110223535000_3.1.e002411.22","doi-asserted-by":"publisher","DOI":"10.1080\/0266476042000214501"},{"key":"2025083110223535000_3.1.e002411.23","unstructured":"World Bank . Physicians (per 1,000 people). 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