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Antibiotics lose effectiveness when they are used inappropriately, but resistance is not simply a problem of patients taking too many pills. Poor diagnostics, preventable infections, weak surveillance and regulation, unreliable supplies, and lack of access to the right medicines can all undermine treatment. Preserving antibiotics means improving appropriate use while ensuring people can get effective treatment when they need it.
What antibiotic resistance means—and why management matters
Antimicrobial resistance (AMR) occurs when microorganisms no longer respond to medicines, making infections harder or sometimes impossible to treat. AMR includes resistance in bacteria, viruses, fungi, and parasites; this article focuses on antibiotics and bacterial resistance.
The scale is substantial, but the measures describe different things. The World Health Organization (WHO), in a fact sheet updated 16 July 2026, says bacterial AMR was associated with more than 4.7 million deaths globally in 2021. “Associated with” does not mean every one of those deaths was directly caused by resistance. The same fact sheet reports that about one in six laboratory-confirmed bacterial infections worldwide was resistant to antibiotics in 2023.
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WHO also reports that resistance rose in more than 40% of monitored pathogen–antibiotic combinations between 2018 and 2023, with an average annual increase of 5–15% in those monitored combinations. This is a surveillance finding, not a forecast for every infection or country. WHO says one in three reported infections was resistant in its South-East Asia and Eastern Mediterranean regions; that regional measure should not be generalized to the world as a whole.
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How poor management makes effective antibiotics harder to preserve
Inappropriate use creates avoidable selection pressure
When antibiotics are used when they are not needed, or the wrong antibiotic is used, susceptible bacteria can be suppressed while resistant bacteria survive and spread. WHO identifies misuse and overuse as major drivers of AMR, including taking antibiotics for infections for which they are not appropriate. The issue is not that every antibiotic prescription is harmful: these medicines remain essential for treating bacterial infections when selected appropriately.
Too little access can also lead to poor treatment
Reducing unnecessary use is not the same as reducing all use. People who cannot obtain appropriate medicines, vaccines, or diagnostic tests may go untreated or receive treatment that is not well matched to their infection. WHO includes limited access to these tools among the factors contributing to AMR. Stewardship therefore has two obligations: avoid inappropriate antibiotic use and make effective treatment accessible when it is needed.
Weak infection prevention increases demand
When infections are not prevented or controlled, more people may need antibiotics. WHO identifies inadequate infection prevention and control, as well as poor water, sanitation, and hygiene, as contributors to AMR. Prevention is part of preserving medicines because it can reduce the infections for which antibiotic treatment is required.
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Stockouts can leave clinicians without a suitable first-line option. Manica Balasegaram, executive director of the Global Antibiotic Research and Development Partnership, wrote in a 2023 commentary republished by Gavi that “Shortages of first-line antibiotics often lead to overuse of those that are specialized or kept in reserve for emergencies.” This is expert commentary on a possible mechanism, not a quantified estimate of the global effect. Balasegaram also noted that shortage levels are difficult to measure precisely.
Gaps in data, regulation, and disposal weaken the response
Laboratories and surveillance systems help identify which infections are resistant and track changing patterns. Without that information, health systems have less ability to guide treatment and monitor progress. Weak regulation can also make it harder to ensure antibiotics are sold and used appropriately. Antibiotic use in human and animal health, along with unsafe waste management, connects the problem across sectors and the environment.
What antibiotic stewardship means in practice
Stewardship means coordinating how antibiotics are selected, supplied, prescribed, monitored, and used so that patients receive effective treatment while avoidable use is reduced. It is a health-system responsibility, not a consumer decision about which drug to request.
AWaRe helps monitor use; it does not choose treatment for an individual
WHO groups antibiotics into Access, Watch, and Reserve categories. Access antibiotics are recommended first-choice treatments for many common infections; Watch antibiotics need careful monitoring, and Reserve antibiotics are kept for situations where other options may not be suitable. The categories support population-level monitoring and stewardship. A clinician’s choice for an individual still depends on the diagnosis and circumstances.
WHO’s 2026 fact sheet reports that Access antibiotics made up 53% of global human antibiotic use in 2022, while roughly 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 of antibiotic-use patterns, not a recommendation that patients seek a particular category.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What the system response needs to address
There is no single intervention that fixes AMR everywhere. WHO and the National Academies’ 2020 workshop proceedings describe a connected response involving prevention, appropriate use, evidence, access, and research. The table shows how common management gaps connect to practical system priorities.
| Management gap | Why it matters | System priority |
|---|---|---|
| Unnecessary or poorly targeted prescribing | Inappropriate use contributes to resistance and may expose patients to medicines they do not need. | Support appropriate prescribing and use; monitor patterns such as AWaRe categories. |
| Limited diagnostics and surveillance | Health systems have less information about the cause of infection and resistance patterns. | Strengthen laboratory capacity, data collection, and surveillance. |
| Weak infection prevention | Preventable infections add to the need for treatment. | Improve infection prevention and control, and water, sanitation, and hygiene. |
| Limited or unreliable access and supply | Patients may not obtain suitable treatment, and clinicians may face shortages of first-line medicines. | Improve equitable access, supply reliability, procurement coordination, and affordability. |
| Fragmented oversight across sectors | Human and animal antibiotic use, regulation, and environmental waste are interrelated concerns. | Coordinate governance across health, agriculture, and environmental systems, including safe waste management. |
| Few new medicines in development | Resistance can undermine available treatments while the pipeline remains limited. | Support research and development alongside stewardship and prevention. |
WHO’s 2026 fact sheet describes a “research and development crisis, with few new medicines in the pipeline.” New medicines are not a substitute for preventing infections, maintaining access, or using current treatments appropriately; these efforts need to work together.
A dated regional example shows why local context matters
A WHO Eastern Mediterranean Regional Committee paper, EM/RC69/7, reported that in 2019 Access, Watch, and Reserve antibiotics accounted for 34%, 61%, and 5% of reported prescribed antimicrobial use in that region. The same report said five countries enforced prescription-only antimicrobial sales and two had adopted AWaRe classification in national essential medicines lists at the time described. These are regional historical figures, not a current 2026 snapshot or a measure of the global situation.
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1Clear out junk files and repair common Windows errors2Scan for outdated or missing drivers - takes under a minute3Repair Windows errors before they cause bigger problemsThe example illustrates why policy and surveillance need to be interpreted in context. A regional use pattern or regulation count cannot establish what is happening in a different region, or whether the same policies remain in place today.
What individuals can do—and what they cannot fix alone
- Use antibiotics only when a qualified health professional determines they are appropriate; they are not a treatment for every infection.
- Do not self-prescribe or use leftover antibiotics. Ask a health professional how to handle medicines you no longer need and follow local disposal guidance.
- Do not treat stewardship as a reason to delay care or go without prescribed treatment. Access to appropriate medicines and timely professional advice is part of the solution.
Individual choices matter, but patients cannot repair shortages, expand laboratory capacity, enforce sales rules, improve infection control, or coordinate national supply chains on their own. Those require coordinated action by health professionals, laboratories, regulators, supply managers, governments, and the human, animal, and environmental health sectors.
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