On November 12, the World Health Organization (WHO) kicked off World Antibiotic Awareness Week by publishing its first report on global antibiotic consumption. Utilising data collected in 2015 from 65 countries, the report highlights substantial disparities in the systemic antibiotics consumption profiles of different nations, including a 16-fold difference between the highest and lowest usage rates.
The framework in the report was developed using standardised analysis methodology with population-adjusted benchmarks of antibiotics consumption. In the battle against antimicrobial resistance (AMR), this analysis provides important, actionable data for local and national stewardship programmes, which can guide the reduction of unnecessary antibiotic use in some countries and increase care in others.
Global antibiotic consumption has risen dramatically in recent years, growing 65% from 2000-2015. This increase in use has been observed across all of the most commonly prescribed antibiotic classes, including broad-spectrum penicillins, cephalosporins, macrolides, and quinolones. GlobalData’s primary and secondary research have revealed that the emergence of AMR pathogens can be directly linked to the inappropriate use or overuse of antibiotics.
One way to address AMR is through antimicrobial stewardship, an organised set of strategies designed to minimise the emergence of antibiotic-resistant strains and optimise health outcomes. As of 2017, 76% of US hospitals (3,794 in total) had active stewardship programmes. However, the execution of stewardship in low and middle-income countries is more challenging due to poor healthcare infrastructure and limited reporting on antibiotics usage at a national level.
A global action plan
In 2015, the World Health Assembly adopted a global action plan on AMR, which focused in part on obtaining quality antimicrobial consumption data. In low and middle-income countries where clinical data sources are limited, numbers related to import, distribution, or sales were used as a proxy for consumption data. The WHO report shows that the median European consumption of antibiotics was found to be 17.9 defined-daily doses (DDD) per 1,000 people, and Turkey was found to have the highest usage rate in European region, with 38.2 DDD per 1,000 people.
In contrast, the Philippines reported a DDD of 8.21 per 1,000 people, signifying low accessibility of necessary antibiotics and an elevated risk for infection. GlobalData believes that establishing benchmarks is a necessary first step for forming best practices standards that are customised for the needs of individual countries.
The report also provided updates on the WHO’s Access, Watch and Reserve (AWaRe) index, which was developed in 2017 to categorise antibiotics based on treatment profile and risk for development of resistance. The analysis showed that the consumption of higher-risk antibiotics accounted for less than 20% of total antibiotic consumption in some countries, but greater than 50% in others, including Japan and Georgia. Risk assessment will have continued importance as novel pipeline antibiotics are projected to reach the US market next year. These include Nabriva Therapeutics’ Contepo (fosfomycin) and Phase III product lefamulin, a first-in-class pleuromutilin antibiotic.
Global surveillance programmes for antibiotic consumption can benefit from the integration of stewardship measures with technological infrastructure. In some countries, surveillance systems only capture information from the public market and are unable to account for private or informal purchases. GlobalData expects that improvements in the health outcomes of developing countries will depend heavily on expansions in local capacity to monitor and report data.
Internet and telecommunications-driven stewardship programmes have been established in the US and Europe, and can provide remote support based on WHO methodology. The WHO has announced plans to integrate its digital Global Antimicrobial Resistance Surveillance System (GLASS) with consumption data from all countries by 2019.