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

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 WHO recommends AMR National Action Plans (AMR NAPs) to address this threat, but the effectiveness of these plans is unknown.

We 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.

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 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).

Countries 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.