Estimating global trends in total and childhood antibiotic consumption, 2011-2015

Abstract

IntroductionUnderstanding patterns of antibiotic consumption is essential to ensure access to appropriate antibiotics when needed and to minimise overuse, which can lead to antibiotic resistance. We aimed to describe changes in global antibiotic consumption between 2011 and 2015.MethodsWe analysed wholesale data on total antibiotic sales and antibiotics sold as child-appropriate formulations (CAFs), stratified by country income level (low/middle-income and high-income countries (LMICs and HICs)). The volume of antibiotics sold per year was recorded for 36 LMICs and 39 HICs, measured in standard units (SU: 1 SU is equivalent to a single tablet, capsule or 5 mL ampoule/vial/oral suspension) and SU per person, overall and as CAFs. Changes over time were quantified as percentage changes and compound annual growth rates in consumption per person. Analyses were conducted separately for total sales, sales of antibiotics in the Access and Watch groups of the WHO’s Essential Medicines List for children 2017, for amoxicillin and amoxicillin with clavulanic acid.ResultsAntibiotic consumption increased slightly between 2011 and 2015, from 6.85×1010 SU to 7.44×1010 SU overall and from 1.66×1010 SU to 1.78×1010 SU for CAFs. However, trends differed between countries and for specific antibiotics; for example, consumption of amoxicillin as CAFs changed little in LMICs and HICs, but that of amoxicillin with clavulanic acid increased by 6.8% per year in LMICs and decreased by 1.0% per year in HICs.ConclusionsAs measured in standard units in sales data, the rate of increase in global antibiotic consumption may be slowing. However, the trends appear to differ between countries and drugs. In the absence of routine surveillance of antibiotic use in many countries, these data provide important indicators of trends in consumption which should be confirmed in national and local studies of prescribing.

Accounting for variation in and overuse of antibiotics among humans

“…[ 2 ] Antibiotic usage rates are highest for young children. [ 17–24 ] Young children, at critical developmental stages, are commonly exposed to antibiotics in low‐income settings. As reported from a large longitudinal household‐based study, children from eight LMIC countries consumed an average of 4.9 antibiotics courses annually during the first two years of life.…”

Measuring antibiotic availability and use in 20 low- and middle-income countries

“…Some studies have used pharmaceutical sales data, which reflect the antibiotic consumption of whole countries rather than individuals or communities. 5,30,31 Nevertheless, despite the different data sources used, the proportion of prescribed antibiotics that were access antibiotics was broadly similar across paediatric studies. One international study found that 76.0% of all antibiotics used were access antibiotics (compared with 72.4% in our study) and 30.7% were amoxicillin (compared with 33.9% in our study).…”

“…For example, in our study, amoxicillin with clavulanic acid was available at only 17.4% of health facilities, whereas recent global pharmaceutical sales data indicate it is used in almost equal amounts to amoxicillin, which was available at 83.8% of facilities in our study. 31 Similarly, cefixime is also one of the most commonly used antibiotics according to pharmaceutical sales, but was available at only 12.9% of facilities. 31 These discrepancies suggest there may be a divergence between supply and use in some countries.…”

“…31 Similarly, cefixime is also one of the most commonly used antibiotics according to pharmaceutical sales, but was available at only 12.9% of facilities. 31 These discrepancies suggest there may be a divergence between supply and use in some countries. There might be differences in prescribing patterns between health facilities and other vendors who were not covered in our study, but whose antibiotic sales were reflected in pharmaceutical data.…”

Can breastfeeding protect against antimicrobial resistance?

“…Neonatal infections with highly resistant pathogens like extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, which are considered an urgent health threat by the US Centers for Disease Control and Prevention [13], have been documented across the globe and have become increasingly prevalent over the past decade [14,15]. Children under two are also one of the likeliest age groups to receive antibiotics [16,17]. Frequent antibiotic exposures may increase the relative abundance of antibiotic resistance genes (ARGs) harbored by gut bacteria, and foster a gut environment supportive of their transfer to pathogens [4,[18][19][20].…”