Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

Abstract

Studies on antibiotic utilization trends are invaluable because they offer data for evaluation of impacts of antimicrobial stewardship policies. Such studies help determine correlations between the use of specific antibiotic classes and trends in emergence of resistance (resistance-epidemiology). This study aims to quantify the consumption systemic antibiotics (J01)—in defined daily doses (DDD) per 1000 inhabitants per day (DID)—in Ethiopia’s public healthcare sector (2016–2020). By so doing, it attempts to capture the extent of population exposure to antibiotics in the country. Data were also compared with those from Norway to establish rough estimate of the country’s status vis-à-vis some globally acknowledged better practices with regard to optimal use of antibiotics. Raw data obtained from registers of Ethiopian Pharmaceutical Supply Agency were converted into DDD, per the standard methodology recommended by WHO. To control for population size, antibiotics consumption data were presented as DID. Since official population census data for Ethiopia were not available for the study period, population projection data from the World Bank were used. Community-based consumption of systemic antibiotics increased from 11.02 DID in 2016 to 12.83 DID in 2020 in Ethiopia—an increase by 16.4%. Moreover, analysis of a log-linear regression model showed that the average growth rate in the community-based systemic antibiotics consumption per year between 2016 and 2020 was about 3.3% (R2 = 0.89). The highest percentage change in community-based systemic antibiotics consumption happened for glycopeptides (J01XA) and the fourth generation cephalosporins (J01DE)—1300% and 600% compared to the baseline year (2016), respectively. At product level, 9 antibiotics constituted the common domain in the list of medication cocktails in the drug utilization 90% (DU90%) for the study period. Community-based consumption of systemic antibiotics for Ethiopia and Norway showed opposite trends, calling for public health policy actions in Ethiopia.

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia

“… 37 These high rates of resistance could be related to the high prevalence of irrational antibiotic use and self-prescription practices in Ethiopia. 38 , 39 , 40 , 41 , 42 As a result, these antimicrobials may no longer be considered effective treatment options for infections caused by E. coli and K. pneumoniae . This, in turn, underlines the importance of developing bacteriology laboratory capacity in healthcare facilities to ensure that isolate identification and antimicrobial susceptibility testing results are made available for clinicians.…”

A six years trend analysis of systemic antibiotic consumption in Northwest Ethiopia

“…From 2000 to 2015, the consumption of Watch antibiotics increased by 165.0% in [ 4 ]. In LMICs, antibiotic consumption in Sub-Saharan Africa is very low [ 3 ] and varies across countries, in Tanzania it was 1 54.51 DIDs from 2010–2016 [ 10 ] and 241.41 DIDs from 2017 to 2019 [ 11 ], 58.41 DIDs in Ethiopia from 2016 to 2020 [ 12 ], 104,791,827 DDD in Uganda from 2017 to 2019 [ 13 ], and 19 DIDs in Sierra Leone from 2017 to 2019 [ 14 ]. Overall, antibiotic expenditures are increasing in public healthcare institutions [ 15 ].…”

“…In Ethiopia, data on antibiotic consumption using standard measures like DIDs is limited [ 12 , 17 , 18 ], particularly in the study area. On the other hand, the consumption of antibiotics in outpatient departments was reported to be high [ 17 ], and in inpatient wards, three out of four patients were prescribed antibiotics [ 18 ].…”

Prescribing pattern and associated factors in community pharmacies: A cross-sectional study using AWaRe classification and WHO antibiotic prescribing indicators at Dire Dawa, Ethiopia

“…The fact that antimicrobial resistance is currently thought to be a factor in more than 700,000 deaths annually and that it is anticipated to claim 10 million lives and cost $100 trillion by 2050 is not surprising 19,20 . Because community-based antibiotic usage is a signi cant component of overall antibiotic use, prudent antibiotic use in the ambulatory context aids in the rational use of antibiotics as a whole 21 .…”