The study focuses on data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption Network (ESAC-Net) and 15 countries of the WHO Europe Antimicrobial Medicines Consumption (AMC) Network, and aimed at examining the total consumption and patterns of consumption of antibiotics, i.e. antibacterials for systemic use (ATCa group J01), in defined daily doses (DDDa) per 1 000 inhabitants per day, the relative consumption of oral and parenteral formulations, and the comparative use of WHO Access, Watch and Reserve (AWaReb) antibiotics in 2018, as well as assessing trends over time.
In 2018, the total consumption of antibiotics ranged from 8.9 for Azerbaijan to 34.1 DDD per 1 000 inhabitants per day for Greece, with similar ranges of estimates for ESAC-Net and the WHO Europe AMC Network. However, there were considerable differences in the consumption of various antibiotic groups, with a larger consumption of penicillins and tetracyclines and a lower consumption of cephalosporins and quinolones in ESAC-Net countries than in WHO Europe AMC Network countries.
The relative consumption of parenteral formulations varied within and between networks. For the 26 ESAC-Net countries for which hospital sector data were included, parenteral formulations represented between 3.6% and 23.9% of total consumption. For the 15 WHO Europe AMC Network countries, parenteral formulations comprised between 2.8% and 40.1% of total consumption.
Furthermore, ‘Access’ antibiotics represented more than 60% of total consumption in 17 of 29 ESAC-Net countries, and three of 15 WHO Europe AMC Network countries. The relative consumption of ‘Watch’ antibiotics ranged from 13% (Iceland) to 61% (Slovakia) of total consumption for ESAC-Net countries, and from 34% (Bosnia and Herzegovina) to 69% (Uzbekistan) of total consumption for WHO Europe AMC Network countries. ‘Reserve’ antibiotics represented <1% of total consumption in all countries included in the study.
Between 2014 and 2018, there were statistically significant decreases in the total consumption of antibiotics in eight ESAC-Net countries: Denmark, Finland, Germany, Luxembourg, the Netherlands, Norway, Sweden, and the United Kingdom. This may be due to the longstanding programmes and commitment of these countries toward the prudent use of antibiotics. WHO Europe AMC Network data were characterised by less consistent patterns, with only one country showing a significant increasing consumption trend between 2014 and 2018. This may reflect the nature of the data collection in these countries, as well as shorter histories of interventions tackling antimicrobial resistance.
WHO’s global target that 60% of total antibiotic consumption should be of ‘Access’ agents was met by 14 of 29 ESAC-Net countries in the five years of the study, while only one country in the WHO Europe AMC Network met this target.
The authors said:
“Although the total consumption of antibiotics was similar in the two networks, the distribution of this consumption among the different antibiotic groups varied substantially. The greater consumption of antibiotics in the ‘Watch’ group in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in antibiotic consumption in several ESAC-Net countries illustrate the value of sustained actions to address the prudent use of antibiotics and antimicrobial resistance”.
Antimicrobial resistance is one of the world’s leading public health threats. It is estimated that about 33 000 deaths are attributable to infections with antibiotic-resistant bacteria annually in the European Union/European Economic Area, and 700 000 globally. Ensuring prudent antimicrobial use is a key priority in an effective response to antimicrobial resistance.
