A rapid scoping review of antibiotic access and use barriers among refugee and migrant populations.

Abstract

Background: Antibiotic resistance (ABR) poses a significant global health and development threat from increasing globalization of travel, trade, and animal and human migration. ABR impacts refugees and migrants in unique ways due to increased exposure to infections and inequitable access to healthcare. The objective of this review is to synthesize the evidence on access to and appropriate use of antibiotics by migrants and refugees, identify the barriers they may experience in accessing and using antibiotics, and reflect on global policy entry points to modify such barriers considering the persistent globalization-related impacts on ABR.

Methods: A global rapid scoping review was conducted to collect evidence on barriers to access and appropriate use of antibiotics among migrants and refugees. MEDLINE (Ovid), Scopus, Web of Science, CABI Global Health and the IGO Custom Search Engine were searched for academic and grey literature published in English, French, or Spanish from inception until September 22nd, 2025. A conceptual framework structured data extraction and thematic analysis of barriers to antibiotic use along the access pathway, including approachability, acceptability, availability, accommodation, affordability, and appropriateness.

Results: This review included 125 studies from an array of geographic locations. Migrants and refugees experience barriers along the continuum of care from both the patient and health-system side, impacting access to, and appropriate use of antibiotics. Limited access to resources, prevalence of certain social norms and values, health literacy and beliefs, and autonomy, can impact healthcare seeking and utilization. Health system barriers, such as location and affordability of services or language barriers, can also limit access and appropriate use of quality-assured antibiotics.

Conclusion: Migrants and refugees face structural, financial, and systemic barriers in accessing and using antibiotics. While globalization processes have shaped the barriers migrants and refugees experience when accessing health services, access pathways are heterogeneous and influenced by the health systems of the host countries, and other contextual, non-health policies and factors. Potential policy solutions to mitigate these barriers include initiatives to address country-of-origin norms and values and improving language accessibility. Improved global policy coordination can also address access challenges for migrants and refugees, as tackling ABR requires collective global action.

Clinical trial number: Not applicable.