Nearly Every Country Is Overusing Powerful Antibiotics – And Older Australians Are Among the Most Exposed

A major new global study has found that almost every country in the world is misusing antibiotics – overusing some of the strongest, most resistance-prone medicines while failing to properly reserve the most powerful drugs for the patients who genuinely need them. For older Australians, particularly those in or connected to aged care, the findings sit alongside some sobering local data that makes this far more than an abstract global health story.

What the global study found

Published in The Lancet Public Health, the study analysed antibiotic use across 186 countries, building a framework to estimate how many antibiotics – and which types – each country should ideally be using, based on local infection rates and drug resistance.

Antibiotics are grouped by the World Health Organization into three categories: Access antibiotics (everyday first-line treatments like amoxicillin), Watch antibiotics (stronger medicines meant to be reserved for specific conditions), and Reserve antibiotics (last-resort treatments for the most dangerous, drug-resistant infections).

Researchers calculated that in 2019, roughly 43 billion courses of antibiotics were needed globally to treat all bacterial infections – about one course per person per year – with around 77 per cent of that ideally coming from the Access category. But when compared against real-world data from 67 countries, nearly three-quarters were using more antibiotics overall than necessary. Almost every country studied (99 per cent) was overusing Watch antibiotics specifically, which contribute the most to antibiotic resistance when misused. At the same time, more than half of countries weren’t using enough Reserve antibiotics, meaning some patients with life-threatening drug-resistant infections may not be getting the treatment they need. Sixty per cent of countries were also still prescribing antibiotics the WHO says should no longer be used at all.

Why this matters here in Australia

Australia’s own data tells a strikingly similar story, and it’s one with particular relevance for older readers. The Australian Centre for Disease Control’s most recent national report on antimicrobial use, released earlier this year, found that reports of critical antibiotic resistance rose by 25 per cent in a single year, while less than half of antibiotics prescribed after surgery were considered appropriate.

The aged care findings are especially worth knowing about. In 2024, older Australians in residential aged care were prescribed 14.4 per cent more antimicrobials than the year before, and more than a third of those prescriptions – 34.7 per cent – were used for prolonged periods of over six months. Separate research has found aged care residents are roughly twice as likely to be prescribed a broad-spectrum antibiotic than older people living in the community, with cephalexin the most commonly prescribed antibiotic in aged care despite not being the recommended first choice for common infections. A 2020 Australian study directly linked more than 1,000 deaths to just five resistant bacterial infections that year alone.

Why this isn’t just a hospital problem

Antibiotic resistance sounds like a distant, technical concern until you consider what it actually threatens: the ability to safely treat routine infections, perform surgery, deliver chemotherapy, or manage a hip or knee replacement without a serious complication becoming untreatable. The more that antibiotics are overused or used inappropriately – whether that’s a stronger antibiotic prescribed when a simpler one would do, or a prescription continued for far longer than necessary – the more opportunity bacteria have to develop resistance to them.

For older Australians specifically, this matters on two fronts. First, ageing itself, along with common conditions like diabetes or reduced kidney function, can already make infections more complex to treat, meaning having effective antibiotics available when genuinely needed is critical. Second, anyone with a parent, partner or loved one in aged care may want to feel comfortable asking questions about why a particular antibiotic has been prescribed, and for how long, particularly if a prescription seems to be continuing for months rather than the days or weeks typically needed to clear an infection.

What you can actually do with this information

You don’t need to become an amateur pharmacist to take something useful from this research. A few practical takeaways:

If you’re prescribed antibiotics, ask your GP whether it’s the most appropriate, narrowest option for your specific infection, rather than assuming a stronger antibiotic is automatically better.
Always complete a prescribed course as directed, and don’t request antibiotics for illnesses like colds or the flu, which are caused by viruses and won’t respond to them at all.
If you or a family member is in aged care and has been on a long-term antibiotic prescription, it’s entirely reasonable to ask the treating GP or facility why, and whether the prescription has been recently reviewed.
Be aware that “stronger” or newer isn’t always better – the global research specifically found that Watch and Reserve antibiotics, the more powerful categories, are being overused in exactly the situations where a simple, everyday antibiotic would do the job just as well, while contributing disproportionately to resistance.

The study’s authors are calling for national policies that address both sides of the problem: reducing unnecessary prescribing where it’s happening, while genuinely improving access to the right antibiotics for people who are seriously unwell and need them. In the meantime, being an informed, occasionally questioning patient – for yourself or someone you’re caring for – remains one of the simplest ways individuals can play a part in preserving how well these medicines work for everyone.

This article is general in nature and reports on published research findings. It isn’t personalised medical advice — never stop or change a prescribed antibiotic course without speaking to your doctor first.