Global trends in antibiotic expenditure: analysis of pharmaceutical sales data, 2013 to 2023

Arindam Nandi; Thomas P Van Boeckel; Eili Y Klein; Philippe Denoel; Mariateresa Cipriano; Deepshikha Batheja; David E Bloom

doi:10.1093/infdis/jiaf346

Global trends in antibiotic expenditure: analysis of pharmaceutical sales data, 2013 to 2023

J Infect Dis. 2025 Jul 3:jiaf346. doi: 10.1093/infdis/jiaf346. Online ahead of print.

Authors

Arindam Nandi^{1

2}, Thomas P Van Boeckel^{2

3

4}, Eili Y Klein^{2

5}, Philippe Denoel⁶, Mariateresa Cipriano⁷, Deepshikha Batheja^{8

9}, David E Bloom¹⁰

Affiliations

¹ Population Council, New York, NY, USA.
² One Health Trust, Washington, DC, USA.
³ One Health Institute, University of Zürich, Switzerland.
⁴ Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, Belgium.
⁵ Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ GSK, Rixensart, Belgium.
⁷ GSK, Siena, Italy.
⁸ Indian School of Business, Hyderabad, India.
⁹ One Health Trust, Bengaluru, India.
¹⁰ Harvard T. H. Chan School of Public Health, Boston, MA, USA.

PMID: 40607801
DOI: 10.1093/infdis/jiaf346

Abstract

Background: Human antibiotic consumption is a major contributing factor to antimicrobial resistance (AMR). Understanding the dynamics of the antibiotic market can help improve antibiotic stewardship efforts and encourage innovation.

Methods: We used IQVIA MIDAS® quarterly pharmaceutical sales value and volume data to estimate aggregate and per capita real (inflation-adjusted) annual spending on antibiotics, along with unit values (ratio of sales value and quantity), in 62 countries from 2013 to 2023. We evaluated trends by broad classes of antibiotics and country income groups and conducted multivariate regression analyses to identify associations with factors such as income and health spending.

Findings: Between 2013 and 2023, aggregate and per capita real spending on antibiotics decreased from $49.61 billion to $30.68 billion and from $12.08 to $7.92, respectively. Real spending per unit of antibiotic - which is an indicator of price but not necessarily the final consumer price- also declined from $0.85 (2013) to $0.45 (2023). Spending decreased across country income groups and converged, driven by more rapid reductions in high-income countries compared with other regions. In 2020, spending decreased sharply due to the COVID-19 pandemic, followed by a small rebound. In multivariate analysis, income, health spending, median age, and clean water access were associated positively, while schooling attainment, availability of doctors, and higher state capacity were associated negatively with per 1,000 people spending on antibiotics.

Interpretation: Global spending on antibiotics declined and overall converged among countries from 2013 to 2023. More investment is necessary towards reducing antibiotic use and developing new effective antibiotics.

Keywords: AMR; Antibiotics; antibiotic resistance; antibiotic sales; antimicrobial resistance.

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