Effects of vaccination programmes on antibiotic consumption and antimicrobial resistance: a global scoping review

Vaccination can reduce antimicrobial resistance (AMR) by preventing infections that trigger antibiotic treatment, lowering transmission of resistant vaccine-targeted strains and reducing population antibiotic selection pressure. This scoping review mapped global primary evidence published from 1999 to 2025 on vaccination, antibiotic use and microbiological resistance. The review followed Joanna Briggs Institute (JBI) guidance and was reported using PRISMA-ScR and PRISMA-S. PubMed was searched in June 2026 for records published from 1999 to 2025; Europe PMC, WHO Global Index Medicus, Google Scholar and backward/forward citation searching were retained as supplementary discovery and verification routes. Comparative human primary studies were eligible when vaccination was linked to antibiotic prescribing, dispensing or consumption, or to phenotypic or genotypic resistance. A prespecified term-based prioritization step was followed by detailed title/abstract and full-record assessment. One reviewer conducted initial screening and a second author verified all inclusions and full-record exclusions. Data were charted by vaccine, population, design, outcome and effect estimate, and design-appropriate JBI domains informed interpretation. The PubMed strategy returned 7,433 records; nine additional PubMed-indexed studies were identified through citation chaining. Seventy-four primary studies were included: 35 addressed antibiotic use and 39 direct resistance-related outcomes. Influenza vaccination generally reduced respiratory antibiotic exposure, although null trials and seasonal heterogeneity prevented a universal effect. Pneumococcal conjugate vaccines produced modest reductions in all-cause use, larger syndrome-specific reductions and marked declines in resistant vaccine-type disease. Quantitative examples included 8% vaccine effectiveness against outpatient antimicrobial purchases, a 14.7% indirect reduction in otitis-related antimicrobial purchases and declines in nonsusceptible invasive pneumococcal disease from 43.9 to 3.2 per 100,000 children aged < 5 years in long-term US surveillance. An investigational maternal respiratory syncytial virus vaccine reduced infant antimicrobial prescribing by 12.9%; rotavirus, COVID-19 and typhoid studies extended the pathway beyond influenza and pneumococcus. Serotype replacement and ecological confounding limited inference for total AMR burden. Vaccination is an upstream component of antimicrobial stewardship, with the strongest evidence for reduced influenza-associated prescribing and resistant vaccine-type pneumococcal disease. Vaccine programmes should be integrated with diagnostic and prescribing stewardship and sustained serotype, genomic and antimicrobial-consumption surveillance. Not applicable.