Abstract
ObjectivesSurveillance of antibiotic consumption in the community is of utmost importance to inform and evaluate control strategies. Data on two decades of antibiotic consumption in the community were collected from 30 EU/European Economic Area (EEA) countries. This article reviews temporal trends and the presence of abrupt changes in subgroups of relevance in antimicrobial stewardship.MethodsFor the period 1997–2017, data on yearly antibiotic consumption in the community, aggregated at the level of the active substance, were collected using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. We applied a range of non-linear mixed models to assess the presence of changes in the consumption of antibacterials for systemic use (ATC group J01) and eight antibiotic subgroups.ResultsFor the majority of the studied groups, a country-specific change-point model provided the best fit. Depending on the antibiotic group/subgroup and on the country, change-points were spread out between 2000 and 2013.ConclusionsDue to the heterogeneity in antibiotic consumption in the community across EU/EEA countries, a country-specific change-point model provided the better fit. Given the limitations of this model, our recommendation for the included countries is to carefully interpret the country-specific results presented in this article and to use the tutorial included in this series to conduct their own change-point analysis when evaluating the impact of changes in regulations, public awareness campaigns, and other national interventions to improve antibiotic consumption in the community.
Highlights
Since their discovery, antibiotics have played an important role in the treatment of bacterial infections
Surveillance of antibiotic consumption in both the community and hospital setting is crucial in order to inform and evaluate strategies for prevention and control of antibiotic resistance
We focused on antibacterials for systemic use (ATC J01) and eight specific subgroups: tetracyclines (J01A), b-lactamase-sensitive penicillins (J01CE; narrow-spectrum penicillins) and b-lactamase-resistant penicillins (J01CF; penicillinase-resistant penicillins), cephalosporins (J01DB, J01DC, J01DD and J01DE), combinations of sulphonamides and trimethoprim (J01EE), macrolides (J01FA), fluoroquinolones (J01MA), penicillins with extended spectrum (J01CA; extended-spectrum penicillins) and combinations of penicillins, including b-lactamase inhibitors (J01CR; combinations of penicillins), and nitrofuran derivatives (J01XE)
Summary
Antibiotics have played an important role in the treatment of bacterial infections. Access to effective antibiotics remains of utmost importance in modern healthcare.[1] overuse and misuse of antibiotics have been identified as important factors leading to the increase of bacterial resistance.[2,3,4,5] Because the therapeutic options for treatment of multidrug-resistant bacterial infections are limited, they represent a major public health threat with prolonged hospital stays, increased health care costs and increased mortality.[6,7,8] surveillance of antibiotic consumption in both the community (i.e. primary care sector) and hospital setting is crucial in order to inform and evaluate strategies for prevention and control of antibiotic resistance.
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