Antibiotic Resistance Crisis: WHO Global AMR Report 2026

How Serious Is the Antibiotic Resistance Crisis?

The landmark Global Burden of Bacterial Antimicrobial Resistance study, published in The Lancet in January 2022, estimated that 4.95 million deaths were associated with bacterial AMR in 2019, of which 1.27 million were directly attributable to resistant infections — meaning those deaths would not have occurred if the infections had been caused by drug-susceptible organisms. This makes AMR a leading global cause of death, comparable to HIV/AIDS and malaria combined. Sub-Saharan Africa and South Asia bear the heaviest burden, with the highest rates of AMR-attributable mortality.

The WHO has consistently identified AMR as one of the top 10 global public health threats facing humanity. The six ESKAPE pathogens — Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species — account for the majority of life-threatening hospital-acquired infections and exhibit high rates of multidrug resistance. Methicillin-resistant Staphylococcus aureus (MRSA) alone was associated with more than 100,000 deaths globally in 2019. Carbapenem-resistant Enterobacterales (CRE), sometimes termed "nightmare bacteria" by the CDC, are resistant to nearly all available antibiotics and carry mortality rates exceeding 40-50% in bloodstream infections.

The crisis is driven by multiple factors: overuse and misuse of antibiotics in human medicine (an estimated 30-50% of antibiotic prescriptions in outpatient settings are unnecessary, according to the CDC), widespread use of antibiotics in animal agriculture for growth promotion and prophylaxis, inadequate infection prevention and control in healthcare facilities, poor sanitation and limited access to clean water in low-income settings, and a critically weak pipeline of new antibiotics. The O'Neill Review on Antimicrobial Resistance projected that by 2050, AMR could cause 10 million deaths annually and cost the global economy $100 trillion if left unchecked.

What Are Antibiotic Stewardship Programs?

Antibiotic stewardship programs (ASPs) are systematic, evidence-based approaches to optimizing antimicrobial use in healthcare settings. The CDC's Core Elements of Hospital Antibiotic Stewardship Programs — first published in 2014 and updated regularly — outline seven key components: hospital leadership commitment, accountability (a physician leader), drug expertise (a pharmacist leader), action (implementing stewardship interventions), tracking (monitoring prescribing and resistance patterns), reporting (providing feedback to clinicians), and education. Studies have consistently demonstrated that well-implemented ASPs reduce inappropriate antibiotic use by 20-40%, decrease Clostridioides difficile infections by 30-50%, and lower healthcare costs without adversely affecting patient outcomes.

In the outpatient setting, where the majority of antibiotic prescriptions are written, stewardship efforts focus on reducing unnecessary prescriptions for viral upper respiratory infections, acute bronchitis, and other conditions for which antibiotics are ineffective. The CDC's Be Antibiotics Aware campaign educates both clinicians and patients about appropriate antibiotic use. Delayed prescribing strategies — where a prescription is provided but the patient is advised to fill it only if symptoms worsen or do not improve after a defined period — have been shown to reduce antibiotic consumption by 50-70% in randomized trials for conditions like acute otitis media and uncomplicated urinary tract infections.

Globally, the WHO Global Action Plan on AMR, adopted by all member states in 2015, calls for national action plans that include antibiotic stewardship as a core pillar. As of 2025, more than 170 countries have developed national AMR action plans, though implementation and resourcing vary widely. Low- and middle-income countries face particular challenges in implementing stewardship due to limited diagnostic laboratory capacity, lack of clinical microbiologists, high burden of infectious diseases, and over-the-counter availability of antibiotics without prescription.

What New Antibiotics Are in Development?

The WHO's annual antibacterial pipeline analysis consistently highlights the inadequacy of the current development pipeline relative to the scale of the AMR threat. As of the most recent report, approximately 80 antibacterial agents were in clinical development (phases I-III), but the majority are derivatives of existing antibiotic classes rather than truly novel mechanisms of action. Only a small fraction specifically target the WHO's critical priority pathogens: carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacterales.

Notable recent approvals and late-stage candidates include cefiderocol (Fetroja), a siderophore cephalosporin active against multidrug-resistant gram-negative bacteria including carbapenem-resistant strains; sulbactam-durlobactam (Xacduro), approved in 2023 for carbapenem-resistant Acinetobacter baumannii infections; and ceftobiprole medocaril (Zevtera), approved in 2024 for community-acquired and hospital-acquired pneumonia including MRSA cases. In the pipeline, zoliflodacin, a novel spiropyrimidinetrione targeting bacterial DNA gyrase, has shown promise in Phase III trials for uncomplicated gonorrhea, addressing the critical threat of extensively drug-resistant Neisseria gonorrhoeae.

The fundamental challenge is economic: antibiotics are typically used for short courses, new agents are reserved as last-resort therapies (limiting sales volume), and resistance inevitably develops over time — creating a poor return on investment for pharmaceutical companies. The PASTEUR Act in the US and similar subscription-model initiatives in the UK and Sweden aim to delink antibiotic revenue from sales volume, providing guaranteed payments to companies that develop qualifying novel antibiotics. The CARB-X (Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) partnership continues to fund early-stage research, with over $500 million invested in more than 90 projects since its inception in 2016.