Global antibiotic consumption patterns through the lens of the WHO AWaRe framework: An umbrella review

This umbrella review evaluates global antibiotic consumption patterns using the WHO AWaRe framework. We conducted a systematic search in PubMed, ScienceDirect, and Google Scholar to identify systematic reviews and meta-analyses published between January 2000 and March 2025 reporting antibiotic consumption. Data extracted from 20 included studies showed a global median antibiotic consumption of 51.1%. Regarding antibiotic consumption under the AWaRe framework, the global median consumption was 55.3% for the Watch category, 40.2% for the Access category, and 10.2% for the Reserve category. Substantial variations were observed across the WHO regions. The African Region recorded the highest overall antibiotic consumption (58.3%; range: 27.6-80.6%), followed by the Eastern Mediterranean Region (57.6%; range: 32.8-93.7%), and the South-East Asia Region (56.0%; range: 37.3-78.8%), while the Western Pacific had the lowest (41.4%; range: 32.9-65.4%). Watch antibiotics were the leading choice in almost all regions, indicating a substantial dependence on broad-spectrum antibiotics. These findings suggest insufficient progress towards the WHO and UNGA Access antibiotic consumption targets, underscoring the need for enhanced antimicrobial stewardship interventions globally.