Global increase and geographic convergence in antibiotic consumption between 2000 and 2015.

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.

Global Antibiotic Consumption in Humans, 2000 to 2018: A Spatial Modelling Study

Global antibiotic consumption: A modelling study

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016-2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Impact of the Italian antimicrobial resistance National Action Plan on antibiotic consumption in primary care: An interrupted time series analysis from 1999 to 2024.

Surveillance of antimicrobial consumption helps to understand the pattern of antibiotic utilisation and plays an essential role in tackling antimicrobial resistance. However, a lack of an established surveillance system is a major challenge in combating antimicrobial resistance in low- and middle-income countries (LMICs). This study aimed to determine the pattern of systemic antibiotic consumption at the Teaching Hospital, Jaffna, using the World Health Organization (WHO) methodology for surveillance of antimicrobial consumption. A descriptive study of systemic antibiotic consumption was conducted at the Teaching Hospital, Jaffna, from 2018 to 2022. Supply data were analysed using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Antibiotic consumption volume was expressed in DDD, while outpatient and inpatient consumption rates were expressed as DDD/100 patients and DDD/100 admissions, respectively. The AWaRe (Access, Watch, and Reserve) classification and Drug Utilisation-90% (DU90%) were used to assess consumption patterns. Trends were assessed using curve estimation analysis. The Wilcoxon signed-rank test and Friedman test were performed to determine the significance of changes between years and over five years, respectively. A p value ≤ 0.05 was considered statistically significant. Compared with 2018, overall antibiotic consumption showed a declining trend except in 2019. Oral antibiotics accounted for more than 80% of total consumption, and amoxicillin/clavulanic acid remained the most commonly consumed antibiotic. Access antibiotics accounted for over 70% of total consumption, with an Access-to-Watch ratio > 2 throughout the study period. The DU90% segment remained largely consistent, comprising 11-12 antibiotics. Curve estimation analysis showed non-linear trends in Access and Watch antibiotic consumption. Despite the decline in total antibiotic consumption, the inpatient antibiotic consumption significantly increased in 2021 compared with 2020 (p < 0.001). Analysis of antibiotic supply data showed that the overall pattern of antibiotic consumption remained consistent over a five-year period despite the changes that occurred during the COVID-19 pandemic. Establishing routine monitoring of antibiotic consumption using available data sources in hospitals provides basic information and insights into the problems. These findings could help to plan strategies to improve the antibiotic utilisation in LMICs.

BackgroundAlthough one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone.MethodsThis is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16.ResultsThe mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days).ConclusionAntibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.

In France, antibiotic consumption (ABC) is dramatically high in parallel with the high rate of multidrug-resistant bacteria. For the last few years, a nationwide policy has been implemented at the national level to control and monitor ABC. Since 2002, surveillance networks have been set up with voluntary hospitals to evaluate the antibiotic policy and consumption. The present study was conducted to identify whether specific control measures of the antibiotic policy could reduce ABC in hospitals. Based on the data from the Northern France surveillance system, local recommendations and antibiotic use were collected annually on a standardized questionnaire that had 21 items. ABC was expressed in defined daily doses (DDDs) per 1000 patient-days (PDs). The ABC indicator was the overall antibiotic consumption. A multivariate logistic regression analysis was performed using low (< or =75th percentile) and high (>75th percentile) ABC as the dependent variable. A total of 83/111 hospitals were included in the study. In 75% of the hospitals, total ABC was < or =669.5 DDDs/1000 PDs. The less frequent practices were educational antibiotic programmes (17%), authorization from an antibiotic specialist for selected antibiotics (26%) and systematic reassessment of AB treatment after 72 h (27%). In the multivariate analysis, three variables remained significantly and independently associated (P < 0.05) with ABC: the type of hospital, the proportion of non-acute-care beds and the nominative delivery form as the only antibiotic control measure. Total ABC was lower in hospitals having a nominative delivery form, compared with hospitals not having it. Conversely, ABC was significantly higher in public teaching hospitals compared with non-teaching hospitals. Similarly, ABC was higher in hospitals with a lowest proportion (i.e. < or =25%) of non-acute-care beds compared with hospitals where this proportion was >25%. Specific control measures could lower ABC. Sustained control efforts should focus on antibiotics with the highest potential for emerging bacterial resistance.

Introduction: Many initiatives are being implemented worldwide to reduce antibiotic consumption; however, the comparative analysis of these initiatives and their effectiveness in the face of large-scale variables such as pandemics are not thoroughly examined.In this regard, this study aims to analyze the total antibiotic consumption trends in the ATC group J01 in Trkiye and European countries, explore the differences between countries, and investigate the impact of the recent pandemic on changes in antibiotic consumption data. Materials and Methods: ATC group J01 total antibiotic consumption (hospital + community) data of Trkiye and 19 European countries between 2010 and 2021 were concatenated and compared. Data from the European Centre for Disease Prevention and Control (ECDC) and the Turkish Medicines and Medical Devices Agency (TITCK) were used for the study. Antibiotic consumption data was represented in terms of defined daily dose (DDD) per 1000 patients per day.Results: Despite having the highest antibiotic consumption during the period in focus, Trkiye showed a statistically significant (p= 0.05) decrease with antibiotic consumption data of 41.43 defined daily doses (DDD) per 1000 patients per day between 2010-2015 and 32.24 DDD per 1000 patients per day between 2016-2021.In 2021, when the COVID-19 pandemic was in effect, antibiotic consumption in Europe dropped to 14.91 defined daily doses (DDD) per 1000 patients per day, the lowest level between 2010 and 2021, while in Trkiye it dropped to 24.39 defined daily doses (DDD) per 1000 patients per day recorded in 2020 and increased to 26.97 defined daily doses (DDD) per 1000 patients per day recorded in 2021. Conclusion:Rational drug use practices were effective in reducing antibiotic consumption in Trkiye.However, the trend was disrupted with the 2021 consumption data, indicating a deviation from the previous progress.In contrast, European countries displayed variations in antibiotic consumption levels, but overall, they experienced a decrease in consumption during the COVID-19 pandemic.

Alcohol-Attributable Fraction in Liver Disease: Does GDP Per Capita Matter?

Regional variations in antibiotic consumption in outpatients have been reported previously, but nothing is as yet known about the regional distribution of antibiotic consumption in the hospital sector in Hungary. This study was designed to explore regional variations and investigate determinants of antibiotic consumption in hospital care in Hungary. Regional distribution-based antibiotic sales data were obtained for a 10-year period (1996-2005) for the 20 Hungarian counties. Systemic antibacterial use (Anatomical Therapeutic Chemical code: J01) was expressed as the number of defined daily doses (DDD) per 100 patient-days. The multiple linear regression model was applied to investigate the determinants of regional differences in hospital antibiotic consumption. Independent variables related to health care access, utilization of hospital resources, doctors' workload, type of hospital care provided, and patient's characteristics and infections were considered as possible determinants, and data on these variables were obtained for 2 years (2004, 2005). We also tested the association between hospital and ambulatory care antibiotic consumption in Hungarian regions using the Pearson correlation test. For each year during the 1996-2005 study period, there were large and stable variations in total hospital antibiotic consumption (e.g., min-max(1996): 16.0-28.2; min-max(2005): 15.2-32.2 DDD per 100 patient-days) depending on the region. In the two developed models (Model 1 and Model 2), the number of reported infections accounted for 53% of the observed regional variations in hospital antibiotic consumption (Model 1), and the number of reported infections together with the case-mix index were responsible for 61% (Model 2) . Total antibiotic consumption in hospitals showed a positive correlation (R = 0.71, p = 0.002) with total antibiotic consumption in ambulatory care. The case-mix index and the number of reported infections explained some of the observed regional variations. However, the moderate value of the models in explaining these regional variations suggest that determinants which could not be explored in this preliminary study may also contribute to regional differences. Future studies should aim at collecting data for each individual hospital as well as data on possible determinants for hospital antibiotic consumption.

Consommation des antibiotiques rapportée via les bilans standardisés de lutte contre les infections nosocomiales et relation avec l’ICATB

Global trend of antimicrobial resistance in common bacterial pathogens in response to antibiotic consumption.

Defined daily doses (DDD) are widely used as a unit to measure drug use in hospital and community settings. However, discrepancies exist between DDD and actual prescribed daily dose (PDD). The present study aims at estimating an alternative PDD (PDD-proxy) to calculate rates of systemic antibiotic consumption and to compare these results with those obtained using DDD. The study considered a 9-year period (2004-2012) and included the 17 Health Trusts (HTs) in the Emilia-Romagna Region, Italy. Drugs under study were antibacterials for systemic use (group J01). Data were obtained from the database for hospital drug prescription of Emilia-Romagna Region. The PDD-proxy was estimated by averaging the doses of antibiotic prescriptions from a point prevalence survey for healthcare-associated infections and antimicrobial use, conducted in Emilia-Romagna hospitals in 2012. Significant discrepancies between DDD and PDD were observed, especially for some antibiotics, resulting in DDD rates that were systematically higher than PDD-proxy rates. In 2012, HT median rates of antibiotic consumption were 90 DDD/100 bed days and 70 PDD-proxy/100 bed-days. However, PDD-proxy and DDD rates showed comparable trends within HTs, although some HTs ranked differently when one or the other measure was used. Interquartile ranges of DDD rates were systematically wider than those of PDD-proxy rates in most years in the period of interest. Comparison of HT antibiotic consumption using DDDs may artificially increase observed differences and affect the true HT ranking. Therefore, an additional unit of measurement is useful for in-depth analysis at the local level.

BackgroundAntibiotic resistance poses a considerable public health threat, with data-driven stewardship a main prevention measure. While quantifying antibiotic consumption is a key component of antibiotic stewardship programmes, the choice of denominator for calculating this metric can impact comparative analyses and trend evaluations substantially, influencing targeted stewardship interventions.AimWe aim to evaluate how using hospital sector-specific antibiotic consumption rate denominators at country level impacts country rankings and trends, addressing the limitations of the commonly used 'defined daily doses (DDD) per 1,000 inhabitants per day' metric.MethodsHospital antibiotic consumption data from ESAC-Net and denominator data from Eurostat (‘inhabitants,’ ‘bed-days’ and ‘discharges’) for 2017–2021 were used to calculate hospital antibiotic consumption rates for 24 reporting European Union/ European Economic Area (EU/EEA) countries. Countries were ranked by their consumption rates and trends were analysed to assess the effects of using different denominators.ResultsCountry rankings and 5-year trend analyses varied depending on the denominator used. Antibiotic consumption rates were more similar when using hospital activity-based denominators ‘bed-days’ and ‘discharges’ compared with the population-based ‘inhabitants’ denominator. Differences in country rankings and trends were also seen among rates derived using ‘bed-days’ and ‘discharges’.ConclusionThe study underscores the importance of using hospital activity-based denominators such as ‘bed-days’ and ‘discharges’ when evaluating hospital antibiotic consumption. ESAC-Net’s historical reliance on only ‘DDD per 1,000 inhabitants per day’ is challenged, advocating for the use of multiple hospital activity-based denominators. Corresponding hospital activity denominators for ESAC-Net data will more effectively inform national hospital antibiotic stewardship interventions.