Antimicrobial resistance (AMR) and the declining effectiveness of antibiotic medicines due to misuse are among the biggest threats to global health and a major challenge for global governance in this century. Since drug-resistant bacteria spread easily across borders, government policies that exacerbate or mitigate AMR affect other countries. International organizations and governments addressed the global public good of maintaining antimicrobial protection by creating a soft governance regime largely devoid of legally binding rules and enforcement mechanisms. This article presents a cross-national empirical assessment of the effectiveness of the international AMR regime combining novel data on national action plans and data on antibiotic consumption in 191 countries between 2000 and 2018. We find that the regime sets ambitious goals and achieves broad participation, substantial implementation, and meaningful change in the use of antibiotics. The involvement of the largest consumers of antibiotics has been crucial for both effectiveness and equity.

抗生素耐药性（AMR）和抗生素药物因滥用而导致疗效下降是全球健康面临的最大威胁，也是本世纪全球治理的重大挑战。由于耐药细菌很容易跨境传播，加剧或减轻抗菌素耐药性的政府政策会影响其他国家。国际组织和政府通过建立基本上缺乏具有法律约束力的规则和执行机制的软治理制度来解决维持抗菌保护的全球公共利益。本文结合 2000 年至 2018 年间 191 个国家的国家行动计划的新数据和抗生素消费数据，对国际 AMR 制度的有效性进行了跨国实证评估。我们发现，该制度制定了雄心勃勃的目标，并在抗生素的使用方面实现了广泛参与、实质性实施和有意义的改变。抗生素最大消费者的参与对于有效性和公平性都至关重要。