ArticleBMJ global health2025
An assessment of antimicrobial resistance national action plans and their impact on antibiotic use.
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 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- The Silent Pandemic: Antimicrobial Resistance, a Global Threat with Ancient Roots.Antibiotics (Basel, Switzerland) · 2026Review
- Antimicrobial Consumption and Resistance Dynamics Across Healthcare Level: Global Evidence and Stewardship Implications.Pathogens (Basel, Switzerland) · 2026Review
- Antimicrobial Resistance Along the Food Chain: Spread and Integrated Strategies for Mitigation and Control.Antibiotics (Basel, Switzerland) · 2026Review
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Authors and funding
5 authors.
Funding
Abstract
introductionBy 2050, antimicrobial resistance (AMR) could lead to over 10 million deaths annually and $100 trillion in healthcare costs, making it one of the most urgent public health threats. The WHO recommends AMR National Action Plans (AMR NAPs) to address this threat, but the effectiveness of these plans is unknown.
methodsWe estimate the impact of AMR NAPs on retail sales of all antibiotics across 68 countries from 2014 to 2023 using IQVIAs Multinational Integrated Data Analysis System dataset. We further examine the effect of AMR NAP adoption on the proportion of antibiotic sales by WHO AWaRe (Access, Watch, Reserve) classification. To account for differences in the quality of the AMR NAP, we also examine if countries with a better NAP have differential use of antibiotics following its adoption. Finally, we explore whether countries with higher quality NAPs make differential use of azithromycin during the COVID-19 pandemic.
resultsThe adoption of an AMR NAP did not have a significant impact on total retail antibiotic sales. But when accounting for the quality of the AMR NAP, as identified from an evaluation of NAP plans, we find that high-scoring AMR NAPs significantly increased the proportion of retail sales from Access-class agents (0.031; 95% CI 0.003 to 0.06), and significantly decreased the proportion of Watch-class antibiotics (-0.03; 95% CI -0.055 to -0.005) as compared with those with lower scoring or no NAPs. Countries with high-scoring NAPs also exhibited lower retail azithromycin sales per 1000 persons during the COVID-19 pandemic (-49.08; 95% CI -89 to -9.16).
conclusionsCountries with higher quality AMR NAPs exhibit more appropriate use of essential antibiotics overall and less inappropriate utilisation of azithromycin during the COVID-19 pandemic compared with those with no or low-scoring plans. Well-developed AMR NAPs may be a useful policy tool to promote more judicious antibiotic use globally.
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