Abstract
SummaryBackgroundAntimicrobial resistance (AMR) is a serious threat to global public health. WHO emphasises the need for countries to monitor antibiotic consumption to combat AMR. Many low-income and middle-income countries (LMICs) lack surveillance capacity; we aimed to use multiple data sources and statistical models to estimate global antibiotic consumption.MethodsIn this spatial modelling study, we used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children (aged <5 years) with lower respiratory tract infections in LMICs. Antibiotic consumption data were obtained from multiple sources, including IQVIA, WHO, and the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). The estimates of the antibiotic usage model were used alongside sociodemographic and health covariates to inform a model of total antibiotic consumption in LMICs. This was combined with a single model of antibiotic consumption in high-income countries to produce estimates of antibiotic consumption covering 204 countries and 19 years.FindingsWe analysed 209 surveys done between 2000 and 2018, covering 284 045 children with lower respiratory tract infections. We identified large national and subnational variations of antibiotic usage in LMICs, with the lowest levels estimated in sub-Saharan Africa and the highest in eastern Europe and central Asia. We estimated a global antibiotic consumption rate of 14·3 (95% uncertainty interval 13·2–15·6) defined daily doses (DDD) per 1000 population per day in 2018 (40·2 [37·2–43·7] billion DDD), an increase of 46% from 9·8 (9·2–10·5) DDD per 1000 per day in 2000. We identified large spatial disparities, with antibiotic consumption rates varying from 5·0 (4·8–5·3) DDD per 1000 per day in the Philippines to 45·9 DDD per 1000 per day in Greece in 2018. Additionally, we present trends in consumption of different classes of antibiotics for selected Global Burden of Disease study regions using the IQVIA, WHO, and ESAC-net input data. We identified large increases in the consumption of fluoroquinolones and third-generation cephalosporins in North Africa and Middle East, and south Asia.InterpretationTo our knowledge, this is the first study that incorporates antibiotic usage and consumption data and uses geostatistical modelling techniques to estimate antibiotic consumption for 204 countries from 2000 to 2018. Our analysis identifies both high rates of antibiotic consumption and a lack of access to antibiotics, providing a benchmark for future interventions.FundingFleming Fund, UK Department of Health and Social Care; Wellcome Trust; and Bill & Melinda Gates Foundation.
Highlights
Bacterial infections are a major cause of morbidity and mortality worldwide
We identified large national and subnational variations of antibiotic usage in low-income and middle-income countries (LMICs), with the lowest levels estimated in sub-Saharan Africa and the highest in eastern Europe and central Asia
Added value of this study We provide the first estimates of longitudinal human antibiotic consumption (ATC J01) for 204 countries from 2000 to 2018, using a novel approach that applied spatial modelling techniques and incorporated multiple data sources, including large-scale antibiotic usage surveys
Summary
Bacterial infections are a major cause of morbidity and mortality worldwide. Antibiotics have been hugely successful in improving health outcomes, and alongside improvements in nutrition, clean water, sanitation, and vaccination provision, have aided in the global reduction of under-5 mortality from 216 deaths per 1000 livebirths in 1950 to 39 deaths per 1000 livebirths in 2017, and an increase in male life expectancy from 48 years to 71 years within the same time period.[1,2] The positive impact of antibiotics on health, is threatened by increasing levels of antimicrobial resistance (AMR) worldwide and hampered by the lack of access to essential antibiotics in many low-income and middle-income countries (LMICs).[3,4]The relationship between antibiotic use and the development and spread of AMR is well documented.[5,6,7] A full understanding of the quantities and classes of antibiotics being used globally and in each geographical context is vital to inform national action plans aimed at promoting judicious antibiotic use and reducing the spread and further entrenchment of AMR.[8]Sustainable Development Goal 3.8 specifies the need for “access to safe, effective, quality and affordable essential medicines and vaccines for all”.9 Limited access to antibiotics results in many bacterial infections going untreated, increasing morbidity and mortality,[3] whereas suboptimal dosing and poor pharmaceutical quality contributes to the development and propagation of Lancet Planet Health 2021; 5: e893–904. Bacterial infections are a major cause of morbidity and mortality worldwide. Antibiotics have been hugely successful in improving health outcomes, and alongside improvements in nutrition, clean water, sanitation, and vaccination provision, have aided in the global reduction of under-5 mortality from 216 deaths per 1000 livebirths in 1950 to 39 deaths per 1000 livebirths in 2017, and an increase in male life expectancy from 48 years to 71 years within the same time period.[1,2] The positive impact of antibiotics on health, is threatened by increasing levels of antimicrobial resistance (AMR) worldwide and hampered by the lack of access to essential antibiotics in many low-income and middle-income countries (LMICs).[3,4]. Limited access to antibiotics results in many bacterial infections going untreated, increasing morbidity and mortality,[3] whereas suboptimal dosing and poor pharmaceutical quality contributes to the development and propagation of Lancet Planet Health 2021; 5: e893–904
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