Trends in Prescribing Antibiotics Between 2012 and 2022: High-Income Versus Low-Middle-Income Countries

Kiran Abbas, Moiz Ahmed, Zaheer Babar

Research output: Chapter in Book/Report/Conference proceedingEntry for encyclopedia/dictionarypeer-review


Antimicrobial resistance (AMR) is a major public health threat. This increase in resistance is in line with the high rate of antibiotic consumption, its overuse and misuse.

In low-middle-income countries (LMICs), the trend of AMR has been rising over the last few decades. In contrast, several high-middle-income countries (HMICs) are observing a lower rate of AMR. It is crucial to understand what factors drive the change in AMR in order to abate the rising threat. Changes in antibiotic prescribing trends can help identify the opportunities to combat AMR, globally. Understanding the factors driving differences in prescribing patterns and the challenges faced by both LMICs and HICs can help develop targeted interventions and introduce policies to promote appropriate antibiotic prescribing behavior. This chapter comprehensively evaluated the trends of prescribing antibiotics in LMICs and HICs and evaluated the factors driving these changes.

Our review of antibiotic prescribing trends in HICs revealed a promising pattern of decreasing antibiotic use, which may be attributed to strict regulation of antibiotic use, antibiotic stewardship practices, and greater access to diagnostics modalities. In contrast, LMICs have limited access to diagnostic tests, inadequate healthcare infrastructure, and low awareness of appropriate prescribing practices among healthcare providers and patients. Additionally, there is often limited regulation of antibiotics, and antibiotics are often sold over-the-counter without a prescription.

Overall, inappropriate and excessive use of antibiotics in LMICs and HICs contributes to the development of AMR which poses a considerable global threat. Continued efforts are needed to address the issue of inappropriate prescribing practices. There is a need for concerted efforts to improve antibiotic stewardship, infection prevention and control, and access to quality healthcare in both LMICs and HICs to mitigate the risk of AMR. This chapter reviewed and compared trends in prescribing practices and antibiotic use patterns between 2012 and 2022 in HICs and LMICs, highlighting the similarities and differences between the two groups of countries. Furthermore, the chapter identified challenges and opportunities for improving antibiotic prescribing practices in HICs and LMICs and provided recommendations for policy and practice.
Original languageEnglish
Title of host publicationEncyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy
EditorsZaheer-Ud-Din Babar
PublisherSpringer, Cham
Number of pages12
ISBN (Electronic)9783030502478
ISBN (Print)9783030502478
Publication statusPublished - 10 Jun 2023


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