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A report today from the World Health Organization (WHO) shows a wide range in the amount of antibiotics being consumed in different countries.
The report, released on the first day of World Antibiotic Awareness Week, found that overall antibiotic consumption in 65 countries in 2015 ranged from 4.4 defined daily doses (DDD) to 64.4 per 1,000 inhabitants per day, a 16-fold difference. The publication is the first ever from the WHO to provide a global overview of antibiotic consumption data based on a standardized global methodology.
The WHO says release the data is a critical first step in helping countries understand the amount of antibiotics being used at the national level and how they’re being used. The hope is that accurate, standardized data will enable countries to develop strategies to improve antibiotic use and will aid the global fight against antimicrobial resistance (AMR).
“Collecting data on antibiotic use is of paramount importance to generate the evidence that will enable us to tackle AMR and protect human health,” WHO deputy director-general for programs Soumya Swaminathan, MD, writes in the report.
Large variations in consumption
The bulk of the data come from countries in Europe that have been conducting surveillance on antibiotic use for several years, but 16 low- and middle-income countries were also able to share their national data for the report. This is important, because to date information on antibiotic use in developing countries has been scarce. Since many lack the money and trained staff to establish and run a national surveillance system for antibiotic consumption, the WHO has been helping these countries build monitoring systems over the past few years.
The lowest reported antibiotic consumption (4.4 DDD/1,000 inhabitants per day) was in Burundi, and the highest use (64.4 DDD/1,000 inhabitants per day) was in Mongolia. The countries of WHO’s European region had a median consumption of 17.9 DDD/1,000 inhabitants per day, with a fivefold difference between the highest consuming (Turkey, 38.2 DDD/1,000 inhabitants per day) and lowest consuming (Azerbaijan, 7.7 DDD/1,000 inhabitants per day) countries.
The WHO says the large variations in antibiotic consumption suggest that some countries are clearly overusing antibiotics, but the agency notes that some of the differences may reflect the quality and completeness of the data. For example, some countries, like Burundi, were able to provide data on hospital antibiotic consumption only, while others provided data on community antibiotic consumption only. In addition, a few countries provided data solely from the public sector. The most common data sources were sales and import records.
The report also breaks down consumption by class of antibiotic, with antibiotics grouped according to the WHO’s AWaRe (Access, Watch, and Reserve) categories. The categories were established in the 2017 revision of the WHO’s essential list of medicines to guide responsible antibiotic prescribing and use and to ensure that antibiotics are available when needed.
In 49 countries, the Access category—which consists of first- and second-line drugs for common infections that should be available in all countries—represented more than 50% of antibiotic consumption, led by amoxicillin and amoxicillin-clavulanate. Watch antibiotics, a category that includes third-generation cephalosporins, carbapenems, and other drugs that should be used with caution because of their potential to promote resistance, accounted for less than 20% of consumption in some countries but more than 50% in others.
Reserve antibiotics—last-resort drugs like colistin that are intended for use only against severe multidrug-resistant infections—accounted for less than 2% of consumption in most high-income countries and were not reported by most low- and middle-income countries. The WHO says this could indicate that these countries lack access to these medications.
“It is important to note that national consumption estimates can mask considerable inequalities in access to and consumption of antibiotics within a country,” the report states.
Data will guide stewardship efforts
The WHO initiated its global program on surveillance of antimicrobial consumption in 2015, in response to the lack of quality consumption data and a standardized methodology for data collection. The agency supported 57 low- and middle-income countries with workshops, training sessions, and technical help, and it says it will continue to support these countries in their efforts to improve their surveillance systems, while also increasing the number of countries participating in the program.
The WHO says data on antibiotic consumption will be crucial for helping countries establish national and local antimicrobial stewardship programs. “Linked to surveillance data on antimicrobial resistance, information on the volume and pattern of antimicrobial consumption helps to identify areas of improvement, develop targeted stewardship interventions, and monitor and evaluate the impact of such interventions,” the report states.
Starting in 2019, consumption data will be integrated into the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) IT platform, a web-based platform through which countries will share surveillance data on antibiotic consumption and resistance.
See also:
Nov 12 WHO report
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