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Antibiotic alternatives are not one replacement drug. They are a portfolio: prevent infections with vaccines and infection-control measures, use diagnostics to guide treatment, and develop targeted options such as bacteriophage therapy. These approaches can reduce some infections and antibiotic use, but they do not make effective antibiotics unnecessary or justify delaying indicated treatment.
What does antibiotic resistance mean?
Antibiotic resistance occurs when bacteria can withstand medicines that would otherwise treat them. It is the bacteria—not a person’s body—that becomes resistant. “Antimicrobial resistance” (AMR) is the broader term for resistance in bacteria, viruses, fungi and parasites; antibiotic resistance refers specifically to bacteria and antibiotics.
The distinction matters because different threats need different tools. A vaccine, test or treatment that addresses one pathogen or infection cannot be assumed to work against all resistant bacteria.
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How widespread is the problem?
The World Health Organization’s Global antibiotic resistance surveillance report 2025 analyzed more than 23 million bacteriologically confirmed cases, with 104 countries reporting data for 2023. In its October 2025 release, WHO estimated that one in six laboratory-confirmed bacterial infections causing common infections worldwide in 2023 were resistant to antibiotic treatment.
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This is a surveillance estimate based on reported laboratory data, not a complete count of every infection in every country. WHO also reported that resistance increased in more than 40% of the pathogen–antibiotic combinations it monitored from 2018 to 2023, with an average annual increase of 5–15% across those combinations. These findings describe the monitored combinations, not every bacterium or antibiotic.
What approaches can complement antibiotics?
| Approach | Where it acts | What the evidence or availability establishes | Main boundary |
|---|---|---|---|
| Vaccination | Prevents infections caused by vaccine-targeted pathogens | WHO assessed 44 vaccines against 24 pathogens in a 2024 technical report; its estimate of possible antibiotic reductions is modeled potential | Does not prevent every bacterial infection or treat an infection already underway |
| Infection prevention and control, hygiene, water and sanitation | Reduces opportunities for infections to occur and spread | WHO’s 2024 IPC report describes implementation approaches in health-care settings | Prevention measures are not treatment for an existing bacterial infection |
| Diagnostics and responsible antibiotic use | Informs whether antibiotics are appropriate and which treatment decisions to consider | WHO calls for quality-assured diagnostics alongside responsible antibiotic use and access to appropriate medicines | A test supports a decision; it does not treat infection by itself |
| Bacteriophage therapy | Targets bacteria, including potential targets among resistant bacteria | Human use remains limited; WHO says more clinical evidence is needed before broad routine use | Not an established general substitute for antibiotics |
Vaccines can reduce demand for antibiotics
By preventing a vaccine-targeted infection, vaccination can avert some situations in which an antibiotic might otherwise be prescribed. WHO’s 2024 assessment covered vaccines already licensed as well as candidates still in development, so its estimate is not a report of results from universal use of all those vaccines.
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For vaccines against 23 pathogens, excluding gonorrhoea, WHO estimated the potential to reduce global antibiotic need by 22%, equivalent to 2.5 billion defined daily doses per year. This is a modeled estimate contingent on vaccine development and use. It does not mean vaccination eliminates antibiotic resistance or replaces treatment for infections that still occur.
Preventing infections reduces opportunities for antibiotic use
In hospitals and other health-care settings, infection prevention and control (IPC) helps reduce the chance that patients acquire or transmit infections. Hand hygiene, appropriate infection-control practices, and reliable water, sanitation and hygiene (WASH) measures are part of this prevention layer. They protect patients and communities by reducing infections, rather than by treating resistant bacteria once a patient is ill.
IPC and WASH require implementation in the setting where they are needed. WHO’s 2024 IPC report is an overview of implementation; it does not support assigning a single numerical effect to these measures here.
Diagnostics make treatment decisions better informed
Quality-assured diagnostics can help establish whether an infection is bacterial and, where testing permits, identify which medicines are likely to work. That information can help clinicians avoid antibiotics when they are not indicated and select an appropriate treatment when they are. Diagnostics are useful only when results can inform timely clinical decisions and patients can access the medicines or other care they need.
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Stewardship means using antibiotics responsibly: choosing them when indicated, selecting an appropriate medicine and using it as directed by a qualified clinician. Stewardship is not a reason to withhold needed treatment. In its October 2025 call for action, WHO Director-General Dr Tedros Adhanom Ghebreyesus emphasized responsible antibiotic use alongside access to appropriate medicines, quality-assured diagnostics and vaccines.
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Bacteriophages, often shortened to phages, are viruses that infect bacteria. Their ability to target bacteria has made them a subject of research for resistant infections, including possible use alongside antibiotics. That specificity is also a reason not to treat “phage therapy” as a single off-the-shelf solution: a phage must be relevant to the bacterial target, and evidence and practical access matter for the particular case.
WHO says stronger clinical evidence is needed before phage therapy can be used broadly as a routine human treatment. In western Europe, use is primarily on compassionate grounds for life-threatening situations after other treatments have been exhausted. Local regulatory status and access differ; the available information does not establish a universal approval or routine-care pathway. Phage research also spans animal and environmental settings under a One Health perspective, but that does not establish human clinical effectiveness.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Why are several approaches needed?
No alternative can cover the whole range of infections treated by antibiotics. Vaccines apply to their target pathogens; prevention reduces infection opportunities; diagnostics inform choices; and potential targeted therapies such as phages require evidence for specific uses. Their value depends not just on scientific promise but on safety, effectiveness, feasibility, timely access and implementation in the settings where infections occur.
WHO’s 2024 bacterial priority pathogens list identifies 24 pathogens across 15 families to guide research and development and prevention priorities. It is a way to focus attention on public-health needs, not a list of pathogens for which a replacement treatment already exists. Developers and funders need to build evidence for particular pathogens and uses, while health systems strengthen surveillance, diagnostics, infection prevention and access to effective medicines.
WHO’s 2025 global call to action set targets of a 10% reduction in estimated AMR-related deaths by 2030 and testing capacity for listed pathogens extended to 80% of countries. These are targets, not achieved results. They also illustrate why alternatives need to be recruited as part of a coordinated response rather than treated as a substitute for antibiotics or for access to care.
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