Abstract
Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network.Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action.Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes.Findings: Total J01 consumption in 2015 ranged 8.0–41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4–42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2–56.6, 9.4–28.8, and 7.5–24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3–49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7–38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3–35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest.Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.
Highlights
Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates
2011 data from selected countries of the WHO Europe Antimicrobial Medicines Consumption (AMC) Network were published in 2014 and an analysis of AMC data for 2011–2014 published in 2017 (Versporten et al, 2014; World Health Organization Regional Office for Europe, 2017a). Both analyses reported total consumption of J01 antibacterials for systemic use (DDD per 1000 inhabitants per day [DID]), and the relative use of different pharmacological subgroups including tetracyclines, penicillins, cephalosporins, aminoglycosides, macrolides, and quinolones. These analyses reported the relative consumption of agents recommended as second-line treatment choices including cephalosporins and quinolones on the basis that these metrics might focus attention on areas where antibiotic use could be improved
This study presents updated data from the WHO Europe AMC Network using cross-national comparisons of 2015 antibiotic consumption data for 16 network members where the Ministry of Health approved data sharing and publication
Summary
Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. Strengthening the evidence base through surveillance of AMR and antimicrobial medicines consumption, and optimizing antimicrobial medicines use in human and animal health, are two of the five objectives of the Global Action Plan (GAP) to reduce AMR (World Health Organization, 2015). Routine data collection on antimicrobial consumption in Europe predated the GAP, with reference data on antimicrobial medicines consumption from European Union (EU) member countries along with Norway and Iceland available from 1997 (European Centre for Disease Prevention and Control [ECDC], 2018). Consumption (ESAC) Network (ESAC-Net) utilizes standardized methods to collect and analyze antimicrobial consumption data for both the community and the hospital sector [European Centre for Disease Control (ECDC), 2018]. Since 2011, similar methods have been used in the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network to estimate antimicrobial medicines consumption in 18 non-EU countries and territories of the WHO European region. This work supplements local studies on patterns of antimicrobial consumption (Stratchounski et al, 2001; Malo et al, 2014; Smiljanic et al, 2016)
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