Global review finds consumption of children’s antibiotics varies widely with little correlation between countries’ wealth and types of antibiotics prescribed

4 December 2018

GENEVA – Researchers analyzing the sales of oral antibiotics for children in 70 high- and middle-income countries found that consumption varies widely from country to country with little correlation between countries’ wealth and the types of antibiotics. Of concern is the relatively low-level use of amoxicillin, an antibiotic to treat the most common childhood infections. In addition, the review found the sale of antibiotics which should only be used for specific indications, or “Watch” antibiotics in a quarter of all countries accounted for 20% of total antibiotic consumption. This is of concern since there is a higher risk of bacteria developing resistance to “Watch” antibiotics.

In 2017, the World Health Organization (WHO) grouped antibiotics into three categories – Access, Watch, and Reserve – with recommendations on when each category should be used to ensure antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. This categorization is designed to enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of ‘last-resort’ antibiotics when all others fail.

While the report finds the consumption of “Access” antibiotics made up on average 76% of child-appropriate antibiotic formulations across all countries, the use of amoxicillin in community practice is relatively low (median 31%). Categorized by WHO as an “Access” antibiotic, amoxicillin should be used as first choice for most common antibiotic treatment indications encountered in community practice.

Dr Julia Bielicki, Senior Lecturer at St George’s, University of London, and study lead said: “This is the first attempt at developing simple metrics of global child community antibiotic use based on the WHO’s grouping. The data can be used by countries to assess their antibiotic use patterns for young children. Countries with low Access percentages can identify opportunities for greater use of these antibiotics. Unnecessary use of Watch antibiotics is more clearly identifiable.”

The research was supported by GARDP, the Global Antibiotic Research and Development Partnership. Dr Manica Balasegaram, Executive Director of GARDP, said: “WHO strongly encourages use of ‘Access’ antibiotics to treat the majority of infections for children and adults as they are affordable, generally less toxic and less likely to drive future antibiotic resistance. Providing country policymakers with evidence on what antibiotics are being prescribed in their country is an important first step to help countries tackle inappropriate prescribing of antibiotics. This in turn will help countries deliver their National Action Plan on antimicrobial resistance and ensure antibiotics remain available and effective for generations to come.”

Consumption of oral antibiotic formulations for young children according to the WHO AWaRe groups; an analysis of sales data from 70 middle and high-income countries” was published in Lancet Infectious Diseases on 3 December 2018.

About WHO AWaRe

WHO’s AWaRe index was introduced into WHO’s Essential Medicines List for children in 2017. The index categorises antibiotics into three groups with the aim of improving access and facilitating appropriate prescribing, reducing the potential for development of antimicrobial resistance, and preserved effectiveness of the so-called last-resort antibiotics. The three groups comprise: ‘Access’ which should be used as first choice for most infections; ‘Watch’ for use as a second choice, and to be used sparingly; and ‘Reserve’ for use as a last resort.

About St George’s, University of London

St George’s, University of London is the UK’s only university dedicated to medical and health sciences education, training and research. Our three research institutes focus on biomedical and scientific discovery, advancing the prevention and treatment of disease in the fields of population health, heart disease and infection – three of the greatest challenges to global health in the 21st.

The Paediatric Infectious Diseases Research Group at St George’s, University of London is internationally recognised as a leading centre for PID research. Headed by Professor Mike Sharland, Professor Paul Heath and Dr Kirsty LeDoare, it has an active research programme in vaccine preventable disease, perinatal infection, antimicrobial resistance, healthcare associated infection and optimal use of antimicrobials.


GARDP is a not-for-profit research and development organization that addresses global public health needs by developing and delivering new or improved antibiotic treatments, while endeavouring to ensure their sustainable access. Initiated by the WHO and the Drugs for Neglected Disease initiative (DNDi), GARDP is an important element of WHO’s Global Action Plan on Antimicrobial Resistance that calls for new public-private partnerships to encourage research and development of new antimicrobial agents and diagnostics. GARDP’s R&D programmes include developing antibiotics for newborns with sepsis and paediatric infections, as well as supporting the update of evidence-based treatment guidelines.

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