An assessment of antimicrobial resistance national action plans and their impact on antibiotic use

O'Neill, Emily (2025) An assessment of antimicrobial resistance national action plans and their impact on antibiotic use. BMJ Global Health. ISSN 2059-7908 (In Press)

Text (AMR NAP_Manuscript_EO_Emily O'Neill) - Accepted Version Pending embargo until 1 January 2100. Download (615kB)

Abstract

Introduction: By 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 World Health Organization recommends AMR national action plans (AMR NAPs) to address this threat, but the effectiveness of these plans is unknown. Methods: We estimate the impact of AMR NAPs on retail sales of all antibiotics across 68 countries from 2014 to 2023 using IQVIAs MIDAS 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. Results: The 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 – 0.06), and significantly decreased the proportion of Watch-class antibiotics (-0.03; 95% CI: -0.055 – -0.005) as compared to those with lower scoring or no NAPs. Countries with high scoring NAPs also exhibited lower retail azithromycin sales per 1,000 persons during the COVID-19 pandemic (-49.08; 95% CI: -89 – -9.16). Conclusions: Countries with higher quality AMR NAPs exhibit more appropriate use of essential antibiotics overall and less inappropriate utilization of azithromycin during the COVID-19 pandemic compared to those with no or low scoring plans. Well-developed AMR NAPs may be a useful policy tool to promote more judicious antibiotic use globally.

Item Type:	Article
Divisions:	LSE Health
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine
Date Deposited:	16 Oct 2025 10:30
Last Modified:	16 Oct 2025 13:12
URI:	http://eprints.lse.ac.uk/id/eprint/129816

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