Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study

Abstract

Summary Background Antimicrobial 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. Methods In 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. Findings We 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. Interpretation To 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. Funding Fleming Fund, UK Department of Health and Social Care; Wellcome Trust; and Bill & Melinda Gates Foundation.

Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

“…When thinking about the role of vaccination to combat AMR, the no-infection counterfactual is more appropriate because infections would be eliminated, whereas interventions based on antimicrobial stewardship might be better informed by the susceptible infection counterfactual because some resistant bacteria might be replaced by susceptible bacteria. 22 In either case, the magnitude of the global bacterial AMR problem is very large and likely bounded by the two measures.…”

“…All country-level covariates were modelled estimates that were produced previously for GBD 2019, 20 , 21 or those that were modelled by Browne and colleagues. 22 We describe data inputs for each of ten estimation steps in greater detail in the following subsections and in the appendix (pp 17–18, 31, 34–35, 44, 54). Data input citations are available online.…”

“…These LMIC-specific estimates of antibiotic usage were combined with pharmaceutical sales data from IQVIA, WHO, and the European Centre for Disease Prevention and Control (ECDC) by use of an ensemble spatiotemporal Gaussian process regression model to produce a location-year covariate on antibiotic consumption for all 204 countries and territories included in this study. 22 Additional details on our estimation method for prevalence of resistance are available in the appendix (pp 44–53).…”

Canine saliva is a source of interspecies antimicrobial resistance gene transfer

“…As a common trend among many nations, veterinary use of antibiotics is gradually declining 38,44,52,74,75 . In human medicine, antibiotic sales elevated by 65% in low- and middle-income countries and decreased slightly, by 4% in high-income countries between 2000 and 2015, what adds up as a rise in global antibiotic consumption rates 66,76 . As a presumable conclusion, several genes conferring resistance against clinically important antibiotic groups are present in the salivary bacteriome of dogs that may drift to the genome of bacteria in humans.…”

“…Based on other publications, antibiotic prophylaxis should be recommended for the high-risk patient groups only 64,65 . Amoxicillin-clavulanate, the most commonly used antibiotic in small animal medicine and the first choice for canine bite wounds is a member of broad-spectrum penicillins, that has been a frequently consumed key antibiotic group in the high-income super-region between 2000 and 2018 by a global study 66 . All in all, 23 ARG types were detected in the dog saliva samples that may confer resistance against amoxicillin-clavulanate, that were either the members of blaTEM or OXA family 67,68 .…”