Assessing How Identification Of Oral Antibiotics Impacts Appropriate Community-Based Antibiotic Use In Low And Middle-Income Countries (ABACUS II Study)

Principal Investigator:
Professor Heiman Wertheim


Vietnam, Bangladesh, Thailand, Mozambique, Ghana, South Africa

3 years (2020-2023)

This project aims to build the case for an international system that harmonizes the appearance of antibiotics to facilitate their identification and help efforts aimed at addressing inappropriate antibiotic use.

Antibiotics are crucial for treating infections, but they are often used incorrectly, which can lead to serious problems like antibiotic resistance. This happens when bacteria change and become resistant to the medications designed to kill them.

In many places, especially in low and middle-income countries, antibiotics can be misidentified or confused with other drugs. This confusion can lead to inappropriate use, which is not only dangerous for individual patients but also contributes to the broader issue of drug resistance.


The main goal of the ABACUS II Study is to make it easier to identify antibiotics by their appearance. This could help everyone—from community members to healthcare workers—use antibiotics more appropriately. Here’s what the study focuses on:

  1. Exploring a Standard Look for Antibiotics: The study investigates whether having a harmonized physical appearance for antibiotics could help in their correct identification.
  2. Studying Economic Impact: It looks into the financial burdens caused by the inability to correctly identify antibiotics.
  3. Investigating Antibiotic Quality: The project tests for substandard or fake antibiotics, ensuring the medications people get are safe and effective.

Highlights from the Study

  • Community Empowerment: Clear labeling of antibiotics empowers community members to use antibiotics correctly, which is essential for their health and safety.
  • Policy Brief Presentation: At the ABACUS II Conference in Bangkok in June 2023, findings and recommendations were presented to help improve how antibiotics are identified and used.
ABACUS II conference – June 2023 in Bangkok, Thailand

The ABACUS II Study is not just about making antibiotics easier to recognize; it’s about ensuring that these critical medicines are used correctly to preserve their effectiveness for future generations. By tackling the issue of misidentification and misuse of antibiotics, the study supports global health strategies and empowers communities to make informed decisions about their health treatments.


Annelie A Monnier, Nga T T Do, Kwaku Poku Asante, Samuel Afari-Asiedu, Wasif Ali Khan, Khatia Munguambe, Esperanca Sevene, Toan K Tran, Chuc T K Nguyen, Sureeporn Punpuing, F Xavier Gomez-Olive, H Rogier van Doorn, Celine Caillet, Paul N Newton, Proochista Ariana, Heiman F L Wertheim; ABACUS II consortium
Lancet Glob Health
August 1, 2023
DOI: 10.1016/S2214-109X(23)00258-9


Dodowa Health Research Centre, Ghana

Dodowa Health Research Centre

Dai Hoc Y

Hanoi Medical University


International Centre for Diarrheal Disease Research

Kintampo Health Research Centre

Kintampo Health Research Centre


Mahidol University


Manhica Health Research Centre


MRC-Wits Rural Public Health and Health Transition Research Unit (Agincourt)


Radboud University


Umea University

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University of Oxford

University of Witwatersrand

University of Witwatersrand

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