Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Klein, Eili Y.; Boeckel, Thomas P. Van; Martínez, Elena; Pant, Suraj; Gandra, Sumanth; Levin, Simon A.; Goossens, Herman; Laxminarayan, Ramanan

doi:10.1073/pnas.1717295115

Cited by 2,370 publications

(1,731 citation statements)

References 43 publications

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“…A previous study reported that the increase in global consumption of antibiotics was primarily due to increased antibiotic consumption in low- and middle-income countries (LMICs) [12]. Complex interactions exist between the levels of economic well-being [4], and inequities in drug access persist because many LMICs continue to be burdened with high rates of infectious disease-related mortality and low rates of antibiotic consumption [12]. Therefore, policy interventions in China should be made in consideration of unbalanced regional development and the consequences this may have on antibiotic consumption.…”

Section: Discussionmentioning

confidence: 99%

“…Among Chinese inpatients, 70 out of 100 are using antibiotics [11], which is a significant problem: the maximum rate of inpatient antibiotic usage set by the World Health Organization (WHO) is 30%. Between 2000 and 2015, antibiotic consumption in China increased at a growth rate of 82.6%, from 2.3 to 4.2 billion accumulative defined daily doses (DDDs) [12]. Additionally, as antibiotic prophylaxis effectively prevents postoperative wound infections, antibiotics are widely used in surgery [13].…”

Section: Introductionmentioning

confidence: 99%

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Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

Chen

Wang

et al. 2018

BioMed Research International

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Antibacterial surveillance is an essential measure for strengthening the management of clinical antibiotic use. This study aimed to determine the trends and drivers of inpatient antibiotic consumption in China. A sample of 89 hospitals with complete data from 2011Q1 to 2015Q4 was included. Accumulative defined daily doses (DDDs), antibiotic use density (AUD), and drug variety were calculated to evaluate antibiotic consumption. From 2011Q1 to 2015Q4, the median values of DDDs, AUD, and drug variety dropped by 10.49%, 39.19%, and 27.96%, respectively. Panel regression results showed, for each additional quarter, DDDs reduced by 6.714 DDDs, AUD reduced by 0.013 DDDs per 100 inpatients per day, and drug variety reduced by 0.012 types (p < 0.001). National hospitals were more likely to use antibiotics, with the highest number of DDDs (106 709 DDDs) and AUD (60 DDDs per 100 inpatients per day) and a large number of drug variety (71 types of drug) all reported from national hospitals. Overall, a downward trend of inpatient antibiotic consumption was observed in competitive tertiary general hospitals in China. However, antibiotic use in China, especially in national hospitals, continues to exceed the guidelines set forth by the nationwide antibiotic stewardship program. China must continue to improve surveillance of antibiotic consumption by constructing a more comprehensive, continuous, and targeted stewardship program. Policy interventions in China should be made in consideration of unbalanced regional development and the consequences this may have on antibiotic consumption.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

Chen

Wang

et al. 2018

BioMed Research International

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“…The global antibiotic consumption data (2000–15) for 76 countries show that Pakistan is among the leading LMIC consumers of antibiotics, where the consumption has increased by 65% from 0.8 to 1.3 billion daily defined doses (DDDs) . This is also evident from the national pharmaceutical sales data in Pakistan, which correlate with antibiotic consumption in the country.…”

Section: Introductionmentioning

confidence: 95%

Evaluating consumption and expenditure patterns of antibiotics in tablet and capsule dosage forms: Pakistan Antibiotic Consumption Surveillance (PACS)

Saleem

Hassali

Hashmi

et al. 2020

Pharmacy Practice and Res

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Background Antibiotics are available in the marketplace in the form of tablets and capsules, and are mostly self‐prescribed by patients, with the consequent emergence of antimicrobial resistance (AMR). This study evaluated the consumption patterns of antimicrobials in these dosage forms during 2017 in Pakistan. Methods Data were acquired retrospectively from the International Medical Statistics (IMS) survey, Pakistan. Only the dosage forms of tablets and capsules constituting four major classes of antibiotics were included in the present study. Antibiotic consumption was measured using the World Health Organization's Anatomical Therapeutic Chemical Classification System with Daily Defined Doses (ATC/DDD) methodology. In addition, we calculated the DID as the total DDDs of antibiotic consumed in a defined period in that area per 1000 people. Expenditure was measured in Pakistan rupees (PKR) and converted to US dollars. Results Total consumption of tablet and capsule dosage forms of antibiotics was found to be 10.6 DID, whereas total expenditure was US$221.5 million (26.69 billion PKR). Of all antibiotics, the most widely consumed were co‐amoxiclav (1.89 DID), levofloxacin (DID 1.41), ciprofloxacin (DID 1.38) and amoxicillin (DID 1.32). The top class of antibiotics based on expenditure was fluoroquinolones (ATC code J01MA), followed by combinations of penicillins (J01CR), third‐generation cephalosporins (J01DD) and macrolides (J01FA). Conclusions Excessive consumption of broad‐spectrum and clinically important classes of antibiotics was observed. The study findings can serve as baseline data for policy makers and authorities to shape and design policies for the rational and cost‐effective use of antibiotics, reducing the burden of AMR and ensuring the economic use of antibiotics.

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“…As most antibiotics are prescribed in primary care and many of these prescriptions for mainly lower respiratory tract infections (LRTI) such as acute bronchitis is of questionable value, reducing inappropriate prescribing in this setting is paramount . Spain is one of the countries with the highest antibiotic prescribing, observing a slight increase over the last years . Several strategies have been developed to reduce unnecessary antibiotic prescribing in the community with little success, but in general, interventions based on multiple initiatives have been found to be more effective than those focused on only one initiative.…”

Section: Introductionmentioning

confidence: 99%

Reducing antibiotic prescribing for lower respiratory tract infections 6 years after a multifaceted intervention

Molero

Moragas²,

López-Valcarcel

et al. 2019

Int J Clin Pract

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Summary Aims Few studies have evaluated the long‐term impact of interventions on antibiotic prescription for lower respiratory tract infections (LRTI). This study was aimed at evaluating the use of antibiotics prescribed for LRTIs by general practitioners (GP) who underwent a multifaceted intervention carried out 6 years earlier. Methods General practitioners who had completed two registrations in 2008 and 2009 were again invited to participate in a third audit‐based study in 2015. A multifaceted intervention was held 1‐3 months before the second registration. A new group of GPs with no previous training on the rational use of antibiotics were also invited to participate and acted as controls. Multilevel logistic regression was performed considering the prescription of antibiotics as the dependent variable. Results A total of 121 GPs of the 210 who underwent the intervention (57.6%) and 117 control GPs registered 4333 episodes of LRTIs. On adjustment for covariables, compared with the antibiotic prescription for LRTIs observed just after the intervention, antibiotic prescription slightly increased 6 years later among GPs who had undergone the intervention (OR 1.17, 95% CI 0.95‐1.43), while control GPs prescribed significantly more antibiotics (OR 2.31, 95% CI 1.62‐3.29). However, withholding antibiotic prescribing with C‐reactive protein (CRP) values <10 mg/L was more frequently observed just after the intervention compared 6 years later (12.7% vs 32.2%; P < 0.01). Conclusions Antibiotic prescribing for LRTIs remains low 6 years after an intervention, although GPs are less confident to withhold antibiotic therapy in patients with low CRP levels.

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Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Cited by 2,370 publications

References 43 publications

Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

Evaluating consumption and expenditure patterns of antibiotics in tablet and capsule dosage forms: Pakistan Antibiotic Consumption Surveillance (PACS)

Reducing antibiotic prescribing for lower respiratory tract infections 6 years after a multifaceted intervention

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