A recent study on antibiotic use across the World Health Organization (WHO) European region shows wide variations in consumption among some countries, declines in others, and opportunities for better antibiotic prescribing.
Published in June in Frontiers in Pharmacology, the study analyzed data from 2014 to 2018 from 30 countries in the European Surveillance of Antibiotic Consumption Network (ESAC-Net) and 15 countries in the WHO Europe Antimicrobial Medicines Consumption (AMC) Network, examining total consumption, trends, and alignment with the WHO's Access, Watch, and Reserve (AWaRe) classification system, which monitors appropriate antibiotic use.
Overall, the analysis found total antibiotic consumption was similar in the two networks, with a population-weighted mean total consumption of 20.0 defined daily doses (DDD) per 1,000 inhabitants per day in ESAC-Net countries and 19.6 DDD for WHO Europe AMC Network countries. Large variations in consumption were observed across countries in both networks, ranging from 8.9 DDD per 1,000 inhabitants per day in Azerbaijan to 34.1 DDD in Greece.
Between 2014 and 2018, eight ESAC-Net countries saw statistically significant decreases in total antibiotic consumption: Denmark (-2.5%), Finland (-5.2%), Germany (-3.4%), Luxembourg (-1.3%), Netherlands (-1.5%), Norway (-2.5%), Sweden (-2.9%), and the United Kingdom (-2.9%). As the study points out, these are countries that have longstanding commitments to reducing antibiotic use.
Two countries in ESAC-Net—Greece (+2.5%) and Iceland (+4.5%)—saw statistically significant increases in antibiotic consumption. No countries in the WHO Europe AMC Network showed statistically significant changes except for Bosnia and Herzegovina (+6.0%), the authors note.
There were also significant differences in consumption of various antibiotic classes between the two networks. ESAC-Net countries consumed more penicillins, tetracyclines, and fewer cephalosporins and quinolones than WHO Europe AMC Network countries.
Consumption of Access, Watch antibiotics
When looking at data stratified by AWaRe antibiotic classifications, the authors found that Access antibiotics comprised more than 60% of total consumption in 59% of ESAC-Net countries, compared with only 20% of WHO Europe AMC Network countries. The population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network.
Access antibiotics are first-line, narrow-spectrum agents that are recommended for most common bacterial infections, and the WHO has set a global target that Access antibiotics should comprise 60% of a country's total consumption. Fourteen of 29 (48%) ESAC-Net countries met this target in each of the 5 years studied, compared with only one of the WHO Europe AMC Network countries.
Consumption of Watch antibiotics, which are broader-spectrum antibiotics not recommended for routine use because of their potential for promoting antibiotic resistance, was higher in the WHO Europe AMC Network countries, ranging from 34% (Bosnia and Herzegovina) to 69% (Uzbekistan), compared with 13% (Iceland) to 61% (Slovakia) in ESAC-Net countries.
Use of Reserve antibiotics, which should only be used for multidrug-resistant infections, represented less than 1% of total consumption in all countries.
The authors of the study say high-level consumption of Watch antibiotics is an obvious target for antimicrobial stewardship interventions.
"Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially," they wrote. "The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing."
The authors also note that relying on total antibiotic consumption rates is an inadequate way to assess how countries are doing when it comes to appropriate antibiotic use.
"More detailed analyses at the formulation, group, and individual agent level are needed to identify useful targets for national interventions to improve the use of antibiotics and promote alignment of clinical practices with international guidance on their responsible use," they wrote.
