Written By: Shreya Bendsure, BPharm and Sheetal Barbade, BPharm
Reviewed By: Pharmacally Editorial Team
Antibiotic resistance has now become a serious global crisis, not just a future concern. The 2025 WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) report found over 23 million infections in 104 countries caused by bacteria that no longer respond to common antibiotics. While more countries are tracking the problem, the report shows a major gap between rich and poor nations. Low- and middle-income countries face the highest number of resistant infections but often lack the labs, medicines, and systems needed to control them. WHO warns that if this trend continues, common infections could once again become deadly.
Resistance Is Spreading Faster Than Surveillance
WHO’s GLASS program now includes 127 countries, but the quality and depth of data collection differ widely. Most drug-resistant infections are reported from areas that struggle the most to manage them, such as sub-Saharan Africa and Southeast Asia, where diagnostic systems are still weak.
This gap means the actual number of resistant infections is likely higher than what reports show. The main challenge is not just detecting resistant bacteria, but also connecting lab results with patient information, treatment outcomes, and local antibiotic use something few health systems are currently able to do.
The Most Affected Antibiotic Classes
The report reveals worrying levels of resistance to several key groups of antibiotics.
Carbapenems, generally considered “last-resort” drugs, are losing effectiveness over 54% of Acinetobacter bacteria worldwide are resistant to imipenem, with rates above 85% in countries like Iran and Egypt.
Third-generation cephalosporin, such as ceftriaxone and cefotaxime, also show high resistance levels of around 40–50% in E. coli and Klebsiella pneumoniae, particularly in bloodstream and urinary infections.
Fluoroquinolones, including ciprofloxacin and levofloxacin, are becoming ineffective as well, with global resistance rates above 40% and over 60% in several Asian and African regions.
Even co-trimoxazole, a commonly used and affordable antibiotic in many low-income countries, now shows resistance rates above 50%. This signals a serious loss of effectiveness for one of the most accessible first-line treatments for common infections.
Bacteria Redefining Modern Medicine
WHO has identified the “Superbug Seven” the bacteria most responsible for the global antibiotic resistance crisis:
Acinetobacter spp.-A leading cause of hospital-acquired bloodstream infections that are often untreatable
Klebsiella pneumoniae-Increasingly produces carbapenemases, driving outbreaks in hospitals worldwide
Escherichia coli (E. coli)-Commonly linked to urinary tract and bloodstream infections, with resistance to nearly half of tested antibiotics.
Staphylococcus aureus (MRSA)-Still widespread, responsible for about one in four bloodstream infections in many countries
Shigella spp.-Causes severe diarrheal illness, particularly in low-resource regions
Salmonella spp.-A major source of foodborne and diarrheal diseases, now showing resistance to fluoroquinolones and macrolides
Neisseria gonorrhoeae-Rapidly developing resistance to the last remaining treatment options, including cephalosporins
These bacteria thrive where infection control is weak. From neonatal sepsis in Africa to post-surgery infections in Asia, WHO data show that antimicrobial resistance hits the poorest patients the hardest.
Diseases Growing Harder to Treat
WHO’s findings show that antibiotic resistance is directly increasing deaths from several major infections:
Sepsis: Drug-resistant Acinetobacter and Klebsiella are now leading causes of bloodstream infections, resulting in longer hospital stays and higher death rates.
Urinary Tract Infections: Infections caused by E. coli and K. pneumoniae often no longer respond to standard treatments, forcing doctors to use stronger or hospital-only antibiotics.
Gonorrhea: This sexually transmitted infection is becoming almost untreatable in regions such as Europe, Southeast Asia, and the Western Pacific.
Pneumonia and Meningitis: Streptococcus pneumoniae is showing growing resistance to penicillin in Asia and the Eastern Mediterranean, complicating treatment especially in children.
These patterns suggest a troubling future where everyday infections could once again become long-lasting or deadly if newer, effective antibiotics remain out of reach.
Global Hotspots: The Unequal Geography of Resistance
According to Table Annex 6 of the WHO report, several regions have emerged as resistance hotspots:
Carbapenem resistance (60–90%) – Highest in Iran, Egypt, Pakistan, and Turkey
Cephalosporin resistance (50–70%) – Rising sharply in India, Nigeria, Indonesia, and Bangladesh
Fluoroquinolone resistance (>60%) – Most common in India, Iran, and Thailand
MRSA prevalence (>40%) – Found across Southern Europe, the Middle East, and several parts of Africa
These figures highlight how antibiotic resistance is concentrated in regions with dense populations, high antibiotic use, and limited infection-control capacity.
In contrast, countries such as Norway, Japan, and the Netherlands report some of the lowest antibiotic resistance levels worldwide. Their success reflects strong antibiotic stewardship programs, strict infection control, and well-organized healthcare systems. This clear divide shows that economic stability and effective governance play a major role in determining how well countries can manage antimicrobial resistance.
The Global Consequences if Trends Continue
Antibiotic resistance has moved beyond being just a medical issue it now poses serious economic and security risks. WHO estimates that by 2050, up to 10 million people could die each year if current trends continue. Beyond the loss of life, resistance threatens the foundations of modern medicine, including surgeries, cancer treatments, and intensive care.
The report also suggests that hospital-based resistance may be underreported by three to four times, meaning the real global impact is likely far greater. Uncontrolled infections not only cause suffering but also lead to higher healthcare costs, loss of productivity, and widening social inequality.
The Report’s Message to Nations: Act or Face Treatment Collapse
WHO is urging all countries to act faster on antimicrobial resistance (AMR) under the 2030 global targets. The key goals include:
Reducing AMR-related deaths by at least 10% by 2030
Ensuring that 70% of antibiotic use in humans comes from WHO’s “Access” category, which includes the safest drugs with the lowest risk of resistance
Expanding national surveillance systems to monitor at least 80% of the population
Strengthening infection prevention and control programs in all healthcare facilities
For countries with a high burden of resistance, WHO warns that “inaction now will cost lives later.” For wealthier nations, the message is just as direct: sharing resources, funding, and expertise are not optional it’s a global responsibility.
The Way Forward
WHO’s 2025 report is a major scientific effort to gather and standardize global data on antimicrobial resistance (AMR). But collecting data is only the first step. Countries need to turn these insights into action through stronger regulations, wider access to diagnostics, effective antibiotic stewardship, and incentives for developing new drugs.
If governments and healthcare systems fail to respond, we could face a post-antibiotic era where even routine procedures childbirth, surgeries, or dental care carry serious, potentially fatal risks.
Editorial Reflection
The WHO 2025 GLASS report is more than just data it’s a clear warning. It shows that antibiotic resistance is advancing faster than global policies can respond. If we fail to protect antibiotics today, future generations may never benefit from their life-saving power. Addressing this crisis will require shared responsibility, strong reforms, and a committed effort from every country to preserve one of medicine’s most vital tools.
Reference
Global antibiotic resistance surveillance report 2025: WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS). Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.