Progress towards antibiotic use targets in eight high-income countries

Simmons, Bryony; Ariyoshi, Koya; Ohmagari, Norio; Pulcini, Céline; Huttner, Benedikt; Gandra, Sumanth; Satta, Giovanni; Moja, Lorenzo; Magrini, Nicola; Miraldo, Marisa; Cooke, Graham

doi:10.2471/blt.20.270934

Cited by 13 publications

(8 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A global action plan on antimicrobial resistance pointed out that high total antibiotic consumption was the main factor leading to the occurrence of AMR and was also the key to controlling the problem [ 29 ]. The current study showed that total antibiotic consumption in Gansu was higher than in some high-income countries and even higher than in France (37% higher) — the country with the highest antibiotic consumption in ESAC before 2017 [ 30 ]. There is no doubt that compared with high-income countries, the disease burden faced by early LMICs (mainly referred to as the burden of infectious disease) was much larger than the adverse effects caused by AMR (burden of AMR bacterial infection).…”

Section: Discussionmentioning

confidence: 99%

Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province

Cao

Feng

Ma³

et al. 2023

BMC Public Health

View full text Add to dashboard Cite

Background Over the past 20 years, excessive antibiotic use has led to serious antimicrobial resistance (AMR) worldwide, and the phenomenon is particularly serious in China. To this end, the Chinese health sector took a series of measures to promote rational antibiotic use. In this study, to reveal the impact of policies on antibiotic use, we explored the long-term trend and patterns of antibiotic use at public health care institutions from 2012 to 2020 in northwest China, taking Gansu Province as an example. Methods Antibiotic procurement data were obtained from the provincial centralized bidding procurement (CBP) platform between 2012 and 2020. Antibiotic use was quantified using the Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology and standardized using the DDD per 1000 inhabitants per day (DID). Twelve relevant quality indicators were calculated for comparison with the European Surveillance of Antimicrobial Consumption (ESAC) project monitoring results. Results Total antibiotic use increased from 18.75 DID to 57.07 DID and then decreased to 19.11 DID, a turning point in 2014. The top three antibiotics used were J01C (beta-lactam antibacterials, penicillins), J01F (macrolides, lincosamides and streptogramins), and J01D (other beta-lactam antibacterials, cephalosporins), accounting for 45.15%, 31.40%, and 11.99% respectively. The oral antibiotics used were approximately 2.5 times the parenteral antibiotics, accounting for 71.81% and 28.19%, respectively. Different use preferences were shown in public hospitals and primary health care centres (PHCs), and the latter accounted for more than half of total use. The absolute use of all classes of antibiotics in Gansu is almost higher than any of the 31 European countries included in the ESAC, but the relative use of some focused antibiotics is lower than theirs. Conclusions The intervention policies of the health department reduced antibiotic use in Gansu Province, but the proportion of broad-spectrum and parenteral antibiotics was still high. It is necessary to further improve the quality of antibiotic prescriptions and pay more attention to the rationality of antibiotic use in PHCs.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province

Cao

Feng

Ma³

et al. 2023

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…In our report, the overall use of the antibacterials from the Access group fell short of the 60% target set by the WHO, ranging from 28.8% in Jordan to 46.7% in Tunisia [ 29 ]. Several high-income countries in Europe and the US reported a median use of 68% from the Access group through enhancing the use of narrow-spectrum antibiotics (France, Germany, Italy, Japan, Spain, Switzerland, United Kingdom, Northern Ireland, and United States of America) [ 30 ]. The use of the Watch group indicates a preference towards using broader spectrum antibacterials.…”

Section: Discussionmentioning

confidence: 99%

“…and Klebsiella pneumoniae in several countries in EMR [ 8 ]. The use of Reserve antibacterials (e.g., colistin) was highest in UAE, Pakistan, and Lebanon (2.3–2.9%), exceeding the reported overall use in high-income countries (1.5%) [ 30 ]. Colistin is the last-resort treatment against multi-drug resistant Gram-negative pathogens and its high use contributes to the global emergence of colistin-resistant pathogens [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Over-Prescription and Overuse of Antimicrobials in the Eastern Mediterranean Region: The Urgent Need for Antimicrobial Stewardship Programs with Access, Watch, and Reserve Adoption

et al. 2022

View full text Add to dashboard Cite

Excessive antimicrobial use contributes to the development of antimicrobial resistance. In the Eastern Mediterranean region (EMR), there is dearth of information on the prevalence of antimicrobial use in patients hospitalized in acute healthcare settings, clinical indications, types of antimicrobials prescribed, and quality indicators for prescriptions. Between September and December 2019, seven countries in the EMR conducted a standardized point prevalence survey. All patients present in the hospital wards at 8 a.m. on the day of the survey constituted the sample population. We collected data, including patient characteristics, antimicrobials received, therapeutic indication according to predefined lists, and markers of prescribing quality. The survey included data from 139 hospitals in seven countries. Among the 19,611 inpatients surveyed, 11,168 patients received at least one antimicrobial {crude prevalence: 56.9% (95%CI: 56.2–57.6%). The top three classes of antimicrobials prescribed were third-generation cephalosporins (26.7%), beta-lactam penicillins (18.1%), and imidazole derivatives (n = 1655, 9.8%). Carbapenems were most frequently prescribed for the treatment of healthcare-associated infections. Compliance with quality indicators of antimicrobial use was limited where treatment guidelines were available for 41% of antimicrobial prescriptions and targeted antimicrobial treatment represented 21% of therapeutic indications. Overall hospital antimicrobial use was high in countries of the EMR, pointing to the need to design and implement context-specific antimicrobial stewardship programs to optimize antimicrobial use and reduce antimicrobial resistance.

show abstract

“…Several studies have published AWaRe data comparing antibiotic use between and within countries 3 6–13…”

Section: Introductionmentioning

confidence: 99%

“…Some studies report temporal trends in AWaRe data using point-to-point comparisons or linear regression analysis 7–9 11–14. However, these methods assume that data are trending linearly over time, which is unknowable in advance.…”

Section: Introductionmentioning

confidence: 99%

Analysis of antibiotic use patterns in Danish hospitals 2015–2021 using an adapted version of the who aware classification

et al. 2022

View full text Add to dashboard Cite

BackgroundAWaRe is a tool to categorise and guide antibiotic use. Antibiotics are classified in three groups: Access, Watch and Reserve. The Access group contains first choice antibiotics for 25 of the most common infections. Antibiotics in the Watch and Reserve groups should be restricted to cases that cannot be effectively treated with drugs from the Access group.ObjectivesThe primary aim of this study was to evaluate and adapt the WHO 2019 AWaRe classification for use with antibiotic usage data in Danish hospitals. The secondary aim was to study the usefulness of the abxaware; software package for visualisation and analysis of temporal trends in antibiotic use patterns.MethodsWe obtained data on purchases of antibiotics in Danish hospitals from January 2015 to July 2021. Sixty-seven unique drugs had been purchased. To better correspond with Danish guidelines, we moved two drugs one AWaRe level upwards. To help aggregate antibiotics according to AWaRe and visualise use patterns, we developed an R package, abxaware.ResultsAfter adding two drugs that were not included in the original AWaRe classification nearly all antibiotics (>99%) used in Danish hospitals were covered. The abxaware software package for R is a useful tool to help aggregate, visualise and analyse antibiotic use patterns.ConclusionsWith minor modifications, we adapted the AWaRe classification to cover most antibiotics used in Danish hospitals and to reflect Danish treatment guidelines. The abxaware package is a useful tool to aggregate and plot antibiotic usage data according to the AWaRe classification and to test for non-random variation in the percentage use of Access antibiotics.

show abstract

Progress towards antibiotic use targets in eight high-income countries

Cited by 13 publications

References 23 publications

Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province

Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province

Over-Prescription and Overuse of Antimicrobials in the Eastern Mediterranean Region: The Urgent Need for Antimicrobial Stewardship Programs with Access, Watch, and Reserve Adoption

Analysis of antibiotic use patterns in Danish hospitals 2015–2021 using an adapted version of the who aware classification

Contact Info

Product

Resources

About