Antimicrobial Use and Resistance in Brazil: An Overview of Regulatory Measures, Consumption Patterns, and Stewardship Challenges

Antimicrobial resistance is one of the most important global public health challenges, particularly in low and middle-income countries where antimicrobial consumption remains high. In Brazil, several regulatory measures have been implemented over the last decade to improve control over antimicrobial use, including restrictions on over-the-counter sales and strengthened monitoring of antimicrobial dispensing. This article provides an overview of antimicrobial use, regulatory measures, and resistance-related challenges in Brazil. Evidence from epidemiological studies, antimicrobial dispensing records, national monitoring initiatives coordinated by the Brazilian Health Regulatory Agency (ANVISA), the National System for Controlled Product Management (SNGPC), and antimicrobial resistance surveillance efforts, including GLASS/BR-GLASS and national reports on healthcare-associated infections and resistance, was considered to identify trends in antimicrobial consumption, regional variation, and the influence of public health policies. Available data indicate that antibiotics such as amoxicillin, azithromycin, and cephalosporins remain among the most commonly dispensed antimicrobials in community settings. Regulatory measures have strengthened prescription requirements, improved oversight of antimicrobial dispensing, and reduced unrestricted non-prescription sales, although their broader impact on inappropriate clinical use and resistance trends remains heterogeneous across settings. Hospital settings continue to show high rates of broad-spectrum antimicrobial use, especially in intensive care units. The COVID-19 pandemic also influenced antimicrobial use patterns, particularly by increasing the consumption of macrolides despite limited evidence of bacterial coinfection. Continued efforts involving prescriber education, antimicrobial stewardship programs, microbiological diagnostics, and integrated surveillance are essential to support more rational antimicrobial use and help address antimicrobial resistance in Brazil.