E-DRUG: WHO Report on Surveillance of Antibiotic Consumption
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[This new WHO study documents the actual antibiotic usage (in DDD's per 1000
people) in 65 countries. The usage ranges from 4.4 to a very worrying 64.4
DDDs per 1000 population (Mongolia). Hard work is needed to analyse why AB
use is so low in some countries, but extremely high in others. WB]
https://www.who.int/medicines/areas/rational_use/oms-amr-amc-report-2016-201
8/en/
<https://www.who.int/medicines/areas/rational_use/oms-amr-amc-report-2016-2018/en/>
Antimicrobial resistance is a major threat to health and human development,
affecting our ability to treat a range of infections. Treatments for a
growing number of infections have become less effective in many parts of the
world due to resistance. The link between antimicrobial resistance and use
of antimicrobials is well documented. However, little information is
available on antimicrobial use in low-income countries. This report presents
2015 data on the consumption of systemic antibiotics from 65 countries and
areas, contributing to our understanding of how antibiotics are used in
these countries. In addition, the report documents early efforts of the
World Health Organization (WHO) and participating countries to monitor
antimicrobial consumption, describes the WHO global methodology for data
collection, and highlights the challenges and future steps in monitoring
antimicrobial consumption.
Executive summary:
Antimicrobial resistance is a major threat to health and human development,
affecting our ability to treat a range of infections. Treatments for a
growing number of infections have become less effective in many parts of the
world due to resistance. The link between antimicrobial resistance and use
of antimicrobials is well documented. However, little information is
available on antimicrobial use in low-income countries.
This report presents 2015 data on the consumption of systemic antibiotics
from 65 countries and areas, contributing to our understanding of how
antibiotics are used in these countries. In addition, the report documents
early efforts of the World Health Organization (WHO) and participating
countries to monitor antimicrobial consumption, describes the WHO global
methodology for data collection, and highlights the challenges and future
steps in monitoring antimicrobial consumption. Need for a standardized
approach to measuring antimicrobial consumption in order to obtain a
thorough and comprehensive picture of antimicrobial resistance and to be
able to identify areas in which actions are needed, surveillance data are
essential. This includes data on antimicrobial resistance and also
antimicrobial consumption. Surveillance systems should provide data that can
be easily compared, exchanged or used locally, nationally and globally.
Unfortunately, many low- and middle-income countries lack the capacity to
establish and maintain systems to collect and make use of data on
antimicrobial consumption. The WHO methodology for a global programme on
surveillance of antimicrobial consumption provides a common technical basis
for setting up a surveillance system on antimicrobial consumption and allows
for standardized data collection at the national level. The approach has
largely been adapted from the European Surveillance of Antimicrobial
Consumption Network (ESAC-Net) of the European Centre for Disease Prevention
and Control (ECDC) and from the protocol developed by the WHO Regional
Office for Europe for its Antimicrobial Medicines Consumption Network.
Overview of results
Since 2016, WHO has supported capacity building in monitoring antimicrobial
consumption in 57 low- and middle-income countries through workshops,
trainings and technical support. At this stage, 16 of these countries were
able to share their national data with WHO. Other countries are currently in
the process of data collection and validation. In total, 64 countries and
Kosovo1 contributed data on antibiotic consumption for this report, with the
bulk of data coming from the European region and countries with
pre-existing, mature surveillance systems. The consumption data showed wide
intra- and interregional variation in the total amount of antibiotics and
the choice of antibiotics consumed. The overall consumption of antibiotics
ranged from 4.4 to 64.4 Defined Daily Doses (DDD) per 1000 inhabitants per
day. In most countries amoxicillin and amoxicillin/ clavulanic acid were the
most frequently consumed antibiotics. These substances belong to the Access
category of the Model List of Essential Medicines, which includes
antibiotics recommended as first- or second-line therapy for common
infectious diseases and which should be available in all countries. In 49
countries, the Access category of antibiotics represented more than 50% of
antibiotic consumption. Broad-spectrum antibiotics such as third generation
cephalosporins, quinolones and carbapenems are categorized as Watch
antibiotics and should be used with caution because of their high potential
to cause the development of antimicrobial resistance and/or their
side-effects. This report shows great diversity in the level of consumption
of antibiotics in the Watch category, which accounted for less than 20% of
total antibiotic consumption in some countries, but more than 50% in others.
Reserve group antibiotics, which should only be used for specific
indications such as infections with multidrug-resistant bacteria, accounted
for less than 2% of total antibiotic consumption in most high-income
countries and were not reported by most low- and middle-income countries.
Antibiotics such as second generation cephalosporins and some tetracyclines,
which have so far not been classified in the Access, Watch and Reserve
(AWaRe) categories, accounted for a substantial proportion of total
consumption, more than 10% in the majority of countries. Data interpretation
should take the country context into account with respect to the data
sources selected, burden of infectious diseases, access to medicines,
structure of the health care systems, and antimicrobial resistance rates of
the main pathogens.
Way forward
WHO aims to increase the number of countries participating in the global
programme on surveillance of antimicrobial consumption and to continue
supporting low- and middle-income countries in their efforts to build and
improve surveillance systems on antimicrobial consumption adapted to the
national context. Efforts to build national capacity will continue,
including increasing knowledge on utilizing data on antimicrobial
consumption to optimize antimicrobial use, to help ensure the sustainability
of national antimicrobial consumption surveillance programmes in the long
term. The AWaRe categorization provides a suitable framework for target
setting, especially with respect to the use of Access antibiotics, and can
be included as an indicator for monitoring and evaluation in the future. To
improve coordination, the global monitoring of antimicrobial consumption
will be included in the Global Antimicrobial Resistance Surveillance System
(GLASS) IT platform in 2019. This will provide national antimicrobial
resistance programmes and other users of GLASS access to data on both
antimicrobial consumption and antimicrobial resistance. The early
implementation phase of the WHO global programme on surveillance of
antimicrobial consumption revealed the challenges and impediments to
establishing national surveillance of antimicrobial consumption in
resource-limited countries. Nevertheless, the delivery of data from 16 low-
and middle-income countries with newly implemented surveillance systems
demonstrates the feasibility of the approach. The establishment of a global
surveillance system can only be realized in a framework based on the
engagement and contribution of each country and well-coordinated cooperation
between countries, WHO regional offices and WHO headquarters. Continued
commitment to expand and consolidate surveillance of antimicrobial
consumption is essential.
Key messages
. Data on antimicrobial consumption provide an important basis for countries
to better understand the patterns and amount of antibiotics used at the
national level, which can inform policies, regulations and interventions to
optimize the use of antibiotics.
. This report shows the great variation in quantity and type of antibiotics
consumed between the included countries. While the observed variation may be
due to the selection and coverage of data sources, it also reflects an
actual difference in antibiotic use.
. The use of antibiotics appears to be very high in some parts of the world,
suggesting their overuse, whereas it is low in others, which may indicate
limited access to these life-saving medicines.
. Findings from this report confirm the need to take action to ensure that
antibiotics are used appropriately, such as enforcing prescription-only
policies and implementing antimicrobial stewardship programmes.
. Governments and the international community should also ensure equitable
access to antibiotics, for example through strengthening of regulatory
frameworks, procurement and supply chains.
. The process of implementing national surveillance of antimicrobial
consumption has prompted countries to review national regulations,
procurement and supply chains of medicines as a starting point to strengthen
overall pharmaceutical systems.
. The lack of data from large parts of the world emphasizes the need for
continued financial, technical and human resources support to further scale
up the implementation of national surveillance of antimicrobial consumption,
especially in low- and middle-income countries.
. Reporting and sharing data on antimicrobial consumption both nationally
and internationally is an essential element of surveillance and provides
important information in the global fight against antimicrobial resistance.
Link to full report:
https://www.who.int/medicines/areas/rational_use/who-amr-amc-report-20181109
.pdf
<https://www.who.int/medicines/areas/rational_use/who-amr-amc-report-20181109.pdf>
E-DRUG@heatlhnet.org