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Antibiotic consumption rates grew by 46 % after 2000, yet many areas still struggle to access treatments

Antiobitics being taken off a shelf in pharmacy

Global antibiotic consumption rates increased by 46% in the last two decades, according to the first study to provide longitudinal estimates for human antibiotic consumption covering 204 countries from 2000 to 2018. The study, published in Lancet Planetary Health today, was led by the Global Research on Antimicrobial Resistance (GRAM) Project, based in the BDI.

The excess and inappropriate use of antibiotics is an important driver of drug resistant infections, yet data on antibiotic consumption are scarce – particularly for low-income and middle-income countries. In this study, the research team used a novel approach that used statistical modelling techniques and incorporated multiple data sources and types, such as large-scale household surveys in low-and middle-income countries, pharmaceutical sales data, and antibiotic consumption data from the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC).

The results provide a comparative analysis of total antibiotic consumption rates in humans globally, expressed as the number of daily doses per 1000 people. This equates to the proportion of people receiving antibiotics on a daily basis in a given country.

The key findings:

  • Between 2000 and 2018, the global volume of antibiotic consumption increased by approximately 46% (from 9.8 to 14.3 daily doses per 1000 people). In high-income countries, consumption rates remained stable between 2000 and 2018.
  • This increase was mainly driven by low- and middle-income countries, which saw a 76% rise in antibiotic consumption between 2000 and 2018 (from 7·4 to 13·1 daily doses per 1000 people).
  • The largest increases in antibiotic consumption rates were seen in the North Africa and Middle East region (111% increase) and South Asia (116%).
  • Certain classes of antibiotic showed especially high increases, particularly fluoroquinolones and third-generation cephalosporins. In South Asia, for instance, consumption rates for fluoroquinolones increased by 1.8-fold, and for third-generation cephalosporins by 37-fold during the study period.
  • However, overall antibiotic consumption was not equally distributed, and was considerably greater in high- and upper-middle income countries (particularly in North America, Europe, and the Middle East) than in low-income countries (such as sub-Saharan Africa and parts of southeast Asia).
  • Total antibiotic consumption rates showed a nearly ten-fold variation, from as low as 5.0 daily doses per 1000 people in the Philippines, to 45.9 daily doses per 1000 people in Greece.
  • The data showed large variations in the proportion of antibiotics classes used in different geographic contexts. For example, the highest rates of broad-spectrum penicillin consumption were observed in the high-income super-region and the lowest in South Asia.

Dr Annie Browne, GRAM geospatial modeller and the study’s first author, said: ‘Understanding the patterns of global antibiotic consumption can help us address a number of public health challenges, from combating drug resistant infections to providing access to basic treatment.’

Lead author and GRAM scientific lead Professor Christiane Dolecek added: ‘It is imperative to curb the unnecessary demand for antibiotics and combat antimicrobial resistance by improving drinking water and sanitation, vaccine coverage and the availability of rapid diagnostic testing, whilst also increasing access and stewardship of antibiotics when and where they are needed. We hope that this seminal platform and first global country-level benchmarking of antibiotic consumption and usage over a 19-year period up to the pre-COVID-19 era can help inform future interventions to optimise antibiotic use and consumption.’

The GRAM Project is a partnership between the University of Oxford, the Mahidol Oxford Tropical Medicine Research Unit (MORU), and the Institute for Health Metric and Evaluation (IHME). This study was funded by the UK Department of Health and Social Care’s Fleming Fund, Wellcome, and the Bill & Melinda Gates Foundation.