The first report from a World Health Organization (WHO) surveillance network covering parts of Eastern Europe and western Asia indicates that consumption of antimicrobials varies widely across the region, with Turkey the heaviest consumer.
The report assesses antimicrobial consumption in 11 non–European Union countries, all members of the WHO Antimicrobial Consumption (AMC) Network, from 2011 through 2014. Also included in the report is Kosovo, which declared itself independent from Serbia in 2008 but is not universally recognized. (The AMC Network consists of 17 countries in the region, but some did not participate in the report.)
The authors conclude that the variation in consumption may not be explained by differences in population health or disease burden alone and say that more investigation is needed. In a statement, the WHO's Europe office said, "The quantitative data provide a starting point for better understanding the use of antibacterials in clinical practice."
Hans Kluge, MD, MPH, director of the Division of Health Systems and Public Health at WHO Europe, commented, "The assembling and sharing of data from the AMC Network is . . . a sign that national governments are taking antimicrobial resistance seriously as a public health issue."
The report includes a chapter on each of the 12 jurisdictions that contributed data: Albania, Armenia, Azerbaijan, Belarus, Kosovo, Kyrgyzstan, Montenegro, the Republic of Moldova, Serbia, Tajikistan, Turkey, and Uzbekistan.
Fourfold difference in rates
The report focused on antimicrobials for systemic use. Consumption, measured in defined daily doses per 1,000 people per day, ranged from 8.54 in Azerbaijan to 40.4 in Turkey, a more than fourfold difference, the authors found. The mean consumption for all 12 jurisdictions was 24.4 doses per 1,000 people per day.
In August 2016, a group of global health experts proposed that, to counter the rise of antimicrobial resistance, countries should aim to limit their antimicrobial consumption to 8.54 defined daily doses per person per year, which they described as the current global median amount.
For comparison, basic math shows that the consumption reported in the AMC Network study ranges from 3.12 doses per person per year in Azerbaijan to 14.75 doses per person annually in Turkey, with a mean of 8.91. (This was derived by dividing the AMC dose numbers by 1,000 to find the dose per person per day and then multiplying by 365 to get the annual amount.)
The report also showed great variability in the use of injectable systemic antimicrobials, from 4% of total consumption in Turkey to 69% in Azerbaijan.
Beta-lactams used most often
The most commonly used class of antimicrobials was beta-lactams, whose share of the total ranged from 35.4% in Belarus to 65.6% in Azerbaijan, the report says. Cephalosporins accounted for between 6.1% (Azerbaijan) and 30.3% (Turkey) of total consumption, while the share for quinolones ranged from less than 0.1% in Uzbekistan to 17% in the Republic of Moldova.
The report notes that cephalosporins and quinolones are broad-spectrum antibiotics and are considered second-line drugs in many prescribing guidelines. The two groups combined accounted for 10% (Azerbaijan) to 38% (Moldova) of total consumption.
In other findings, "The relative consumption of amoxicillin and the broader-spectrum amoxicillin and clavulanic acid varied widely," the authors said. "Amoxicillin was the more consumed agent in most datasets—the exception was Turkey, where only 11% of consumption of these two agents was amoxicillin."
Data used in the report were collected by national experts from sources including import and customs records, sales records, and estimates of local manufacturing. The authors said the findings have a number of limitations and should be interpreted cautiously.
"Despite this, the levels of [consumption] reported, and in some cases the choices of antimicrobial agents used, confirm the need for action," they concluded. "A commitment to ongoing collection, analysis and use of consumption data is essential: it is a central element laid out in the Global Action Plan on antimicrobial resistance adopted during the Sixty-eighth World Health Assembly in May 2015."
May 1 WHO Europe statement
Full text of WHO AMC Network report (148 pages)
Aug 19, 2016, CIDRAP News story on proposed global targets for cutting antimicrobial use