World Health Organization · 2025
Practical guide for public-health professionals and clinicians on collecting, analysing, and using national antimicrobial use surveillance data to combat antimicrobial resistance.
- Issuer
- World Health Organization
- Edition
- 2025
- Audience
- Public health professionals, health authorities, national AMR focal points, pharmacists, physicians, clinical staff implementing antimicrobial stewardship, data collectors and analysts, policy-makers, and One Health surveillance coordinators.
- Evidence
- Expert consensus and WHO GLASS methodology; draws on established international standards (ATC/DDD system, AWaRe classification) and case studies from GLASS-participating countries; aligned with 2024 UN General Assembly political declaration on AMR.
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guide provides comprehensive, step-by-step methodology for establishing and using national surveillance systems to monitor antimicrobial use (AMU). It covers the complete data cycle from collection through procurement, distribution, and dispensing records to analysis using standardised metrics (DDD/1000 inhabitants/day), interpretation in context, and translation into actionable policies and antimicrobial stewardship programmes.
The guide emphasises the 2024 United Nations target that at least 70% of national antibiotic consumption should be Access antibiotics according to the WHO AWaRe classification. It describes how to assess data quality across five dimensions (completeness, representativeness, precision, internal quality, and comparability), choose appropriate data sources for different health system contexts, and disaggregate data by healthcare level and sector.
Practical case studies illustrate how national AMU data can guide policy interventions—from banning over-the-counter sales and restricting Watch antibiotics to updating treatment guidelines, strengthening procurement systems, and monitoring progress toward national goals. The guide also addresses how to identify signals requiring further clinical investigation and integrate AMU surveillance into broader health information systems.
Key points
For clinicians — doses and thresholds as stated in the guideline
- National AMU surveillance should capture all systemic antimicrobials (ATC codes J01, P01AB, A07AA) using the DDD (defined daily dose) as the standardised numerator metric
- The global target is ≥70% of national antibiotic consumption from Access group antibiotics; median use in 42 GLASS countries (2022) was 10–25 DID (DDD/1000 inhabitants/day)
- Data sources include procurement/import records (least precise but often most complete), distribution/wholesale data (moderate precision), and dispensing/reimbursement data (most precise but often incomplete)
- Oral antibiotics typically represent >90% of total use in primary care; <90% oral use may indicate inappropriate parenteral use in community settings
- Five key data quality dimensions must be assessed: completeness (coverage of total AMU), representativeness (reflects all sectors/regions), precision (accuracy for defined period), internal quality (consistency), and comparability (over time/place)
- DU75 and DU90 metrics identify the antibiotics accounting for 75% or 90% of total use; a small number dominated by Access antibiotics indicates better quality prescribing
- Data disaggregation by AWaRe category, pharmacological subgroup (ATC3/ATC4), route of administration, healthcare sector (public/private), and level (primary/hospital) enables targeted stewardship interventions
- Unexpected findings (e.g., >300% increase in fluoroquinolone use, zero macrolide use, or extremely high/low total use) signal data errors or important contextual changes requiring investigation before interpretation
Characteristics of sources of national medicine-level AMU data (Fig. 6)
Table extracted from the guideline
| Data source | Type | Advantages | Disadvantages | Use case |
|---|---|---|---|---|
| Procurement & supply | Quantities imported and locally manufactured | Often most complete national data; help understand market, availability, cost; disaggregation by sector/level/region possible | Imperfect measure of patient use; does not account for stockpiling/wastage; temporal differences between import cycles and surveillance periods; re-export distortion; stratification by level/region usually not possible | Good starting point when limited capacity/resources for collecting data closer to actual use |
| Distribution | Quantities distributed to pharmacies/hospitals by wholesalers/central medical stores | Good proxy for actual use; often complete national data; some disaggregation possible | Time-consuming when many wholesalers/distributors; risk of incomplete coverage if some sources missing; legal reporting protocols needed | Suitable when few wholesalers/distributors or as improvement over procurement data |
| Prescribing, dispensing, reimbursement | Quantities prescribed, dispensed or administered to patients | Best proxy for actual AMU; disaggregation by sector, level, region, season possible; some demographic data may be available | Compilation from many facilities requires advanced tools; may reduce representativeness; insurance schemes may cover limited population; legal protocols needed; OTC antibiotics not captured | Relevant when electronic medicine record or dispensing systems integrated/collated for all sectors and levels |
Source: World Health Organization, GLASS guide on use of national data on antimicrobial use: informing policies and strengthening stewardship efforts. Reproduced in summary form.
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise this guide as vital infrastructure for our region's antimicrobial resistance response. Georgian clinicians should particularly note the oral-to-parenteral ratio benchmark—when oral antibiotics fall below 90% of primary care use, it signals inappropriate injectable prescribing in community settings, a pattern we observe across the South Caucasus. Our realistic challenge remains capturing complete data from private pharmacies, which dominate retail antibiotic sales in Georgia, alongside informal cross-border medicine trade that existing surveillance systems struggle to quantify. The stepwise approach allows us to begin with customs and import records whilst building capacity for facility-level reporting aligned with our existing GLASS-AMR participation.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guide provides essential methodology for establishing or strengthening national AMU surveillance aligned with European and global standards. Georgian national programmes should consider: (1) the mix of public and private pharmaceutical sectors and potential gaps in capturing private pharmacy dispensing data; (2) integration with existing hospital infection control and GLASS-AMR surveillance if already reporting; (3) alignment of the national essential medicines list with WHO AWaRe principles (the guide emphasises that Access antibiotics should dominate formularies); (4) challenges of informal cross-border medicine trade in the region; and (5) opportunities to benchmark against neighbouring countries through WHO Regional Office for Europe networks. The stepwise approach allows countries to start with readily available procurement or import data while building capacity for more granular facility-level or reimbursement-based surveillance. Surveillance data can directly inform national action plans on AMR, treatment guideline updates, and pharmaceutical procurement strategies relevant to universal health coverage initiatives in the region.
Questions this guideline answers
Quick answers
What is the difference between medicine-level AMU data and clinical AMU data?
Medicine-level data (formerly called AMC data) provide aggregated quantitative information on the types and volumes of antimicrobials used—measured in DDDs—without patient-level details. Clinical data (formerly called AMU data) link medicine use to clinical information such as diagnosis, prescriber, ward, dose, duration, and indication, enabling assessment of appropriateness but requiring more resources to collect. This guide focuses on national medicine-level data; clinical data methods will be addressed in future WHO guidance.
How do I choose the best data source for national AMU surveillance in my country?
The choice depends on your health system structure, data infrastructure, and surveillance maturity. Start by mapping all available sources along the supply chain (import, manufacturing, distribution, dispensing, reimbursement). Procurement/import data are the easiest starting point with broad coverage but least precision. Distribution data from wholesalers offer better precision if there are few major distributors. Dispensing or reimbursement data are most accurate but require electronic systems and may have coverage gaps. GLASS recommends distribution-level data for moderately mature systems. Assess each source for completeness, representativeness, and feasibility of obtaining standardised product information (active ingredient, strength, formulation, quantity).
Our country shows very high use of Watch antibiotics (e.g., azithromycin, ciprofloxacin). What specific actions does the guide recommend?
The guide recommends: (1) integrate AWaRe classification into the national essential medicines list, procurement lists, and insurance reimbursement schemes; (2) restrict distribution of parenteral third-generation cephalosporins and fluoroquinolones to secondary/tertiary facilities; (3) enforce prescription-only dispensing of Watch antibiotics and ban over-the-counter sales; (4) update national treatment guidelines using the WHO AWaRe antibiotic book to prioritise Access antibiotics as first-line options; (5) require AWaRe training and certification of physicians as continuing medical education; (6) establish antimicrobial stewardship teams in hospitals and implement AMS in primary care; and (7) conduct targeted point-prevalence surveys or audits to collect clinical data on appropriateness of Watch antibiotic prescribing for specific indications.
How can countries identify which specific antibiotics should be prioritised for stewardship interventions when national consumption data become available?
The DU75 and DU90 metrics reveal which antibiotics account for 75% or 90% of total use; countries should prioritise interventions on Watch or Reserve antibiotics within these dominant groups, whilst ensuring Access antibiotics constitute the majority of the DU75 segment.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- Overuse of 'Just in Case' Antibiotics Accelerates Antimicrobial Resistance Crisis, Researchers WarnSep 2026
- WHO Adopts New Decade-Long Strategy to Combat Antimicrobial Resistance Through 2036Aug 2026
- Jakarta Hospital Survey Reveals High Antibiotic Resistance in Common Bacterial InfectionsJun 2026
- Osteomyelitis: New diagnostic advances and treatment strategies for bone infectionsMay 2026
Quality & accreditation
- ASF Laboratory — Standard 1 — Governance & Document Control
- ASF Laboratory — Standard 6 — Pre-Examination: Specimen Pathway
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Laboratory — Standard 8 — Post-Examination: Reporting & Critical Values
- ASF Hospital — Standard 4 — Care & Treatment
- ASF Hospital — Standard 7 — Governance & Management
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025
- Status
- Current
- Published
- 2026-03-02
- Languages
- English
- Scope
- National surveillance of medicine-level antimicrobial use (antibiotics, antifungals, antivirals, TB medicines, antimalarials) in the human health sector; methods for data collection from procurement, distribution, and dispensing sources; standardised analysis using ATC/DDD system and AWaRe classification; interpretation in health system context; translation into policies and stewardship interventions.
- Audience
- Public health professionals, health authorities, national AMR focal points, pharmacists, physicians, clinical staff implementing antimicrobial stewardship, data collectors and analysts, policy-makers, and One Health surveillance coordinators.
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789240117129
- Evidence
- Expert consensus and WHO GLASS methodology; draws on established international standards (ATC/DDD system, AWaRe classification) and case studies from GLASS-participating countries; aligned with 2024 UN General Assembly political declaration on AMR.
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
GLASS guide on use of national data on antimicrobial use: informing policies and strengthening stewardship efforts. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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