Objective To compare antibiotic sales in eight high-income countries using the 2019 World Health Organization (WHO) Access, Watch and
Reserve (AWaRe) classification and the target of 60% consumption of Access category antibiotics.
Methods We analysed data from a commercial database of sales of systemic antibiotics in France, Germany, Italy, Japan, Spain, Switzerland,
United Kingdom of Great Britain and Northern Ireland, and United States of America over the years 2013–2018. We classified antibiotics
according to the 2019 AWaRe categories: Access, Watch, Reserve and Not Recommended. We measured antibiotic sales per capita in standard
units (SU) per capita and calculated Access group sales as a percentage of total antibiotic sales.
Findings In 2018, per capita antibiotic sales ranged from 7.4 SU (Switzerland) to 20.0 SU (France); median sales of Access group antibiotics
were 10.9 SU per capita (range: 3.5–15.0). Per capita sales declined moderately over 2013–2018. The median percentage of Access group
antibiotics was 68% (range: 22–77 %); the Access group proportion increased in most countries between 2013 and 2018. Five countries
exceeded the 60% target; two countries narrowly missed it (>55% in Germany and Italy). Sales of Access antibiotics in Japan were low
(22%), driven by relatively high sales of oral cephalosporins and macrolides.
Conclusion We have identified changes to prescribing that could allow countries to achieve the WHO target. The 60% Access group target
provides a framework to inform national antibiotic policies and could be complemented by absolute measures and more ambitious values
in specific settings.