Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Abstract

Tracking antibiotic consumption patterns over time and across countries could inform policies to optimize antibiotic prescribing and minimize antibiotic resistance, such as setting and enforcing per capita consumption targets or aiding investments in alternatives to antibiotics. In this study, we analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries and projected total global antibiotic consumption through 2030. Between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65% (21.1-34.8 billion DDDs), and the antibiotic consumption rate increased 39% (11.3-15.7 DDDs per 1,000 inhabitants per day). The increase was driven by low- and middle-income countries (LMICs), where rising consumption was correlated with gross domestic product per capita (GDPPC) growth (P = 0.004). In high-income countries (HICs), although overall consumption increased modestly, DDDs per 1,000 inhabitants per day fell 4%, and there was no correlation with GDPPC. Of particular concern was the rapid increase in the use of last-resort compounds, both in HICs and LMICs, such as glycylcyclines, oxazolidinones, carbapenems, and polymyxins. Projections of global antibiotic consumption in 2030, assuming no policy changes, were up to 200% higher than the 42 billion DDDs estimated in 2015. Although antibiotic consumption rates in most LMICs remain lower than in HICs despite higher bacterial disease burden, consumption in LMICs is rapidly converging to rates similar to HICs. Reducing global consumption is critical for reducing the threat of antibiotic resistance, but reduction efforts must balance access limitations in LMICs and take account of local and global resistance patterns.

Keywords: antibiotic stewardship; antibiotics; antimicrobial resistance; defined daily doses; low-income countries.

Fig. 1.

Global antibiotic consumption by country: 2000–2015. (A) Change in the national antibiotic consumption rate between 2000 and 2015 in DDDs per 1,000 inhabitants per day. For Vietnam, Bangladesh, The Netherlands, and Croatia, change was calculated from 2005, and for Algeria from 2002 as data before those years for those countries were not available. (B) Antibiotic consumption rate by country for 2015 in DDDs per 1,000 inhabitants per day. Data source: IQVIA MIDAS, 2000–2015, IQVIA Inc. All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas).

Fig. 2.

Global antibiotic consumption by country income classification: 2000–2015. (A) Graph showing how the antibiotic consumption rate in DDDs per 1,000 inhabitants per day has rapidly increased for LMICs, while remaining nearly constant for HICs. However, as shown in B, the larger population sizes in many LMICs result in greater total antibiotic consumption (DDDs) in LMICs even though their consumption rate (and thus per capita use) is lower. In B, each bar reflects total consumption in the specified year for that country or group of countries. Data source: IQVIA MIDAS, 2000–2015, IQVIA Inc. All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas).

Fig. 3.

Antibiotic consumption rate for HICs, LMICs-UM, and LMICs-LM of the four most-consumed therapeutic classes of antibiotics in DDDs per 1,000 inhabitants per day. (A) Broad-spectrum penicillins, which correspond to the Anatomical Therapeutic Chemical (ATC) classification of penicillins with extended spectrum (J01CA) excluding carbenicillins. (B) Cephalosporins, which correspond to the ATC classification codes J01DB, J01DC, J01DD, and J01DE for the four generations of cephalosporins. (C) Macrolides, which correspond to the ATC classification for macrolides, lincosamides, and streptogramins (J01F). (D) Quinolones, which correspond to the ATC classification for quinolone antibacterials (J01M). Data source: IQVIA MIDAS, 2000–2015, IQVIA Inc. All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas).

Fig. 4.

Antibiotic consumption rate for HICs, LMICs-UM, and LMICs-LM of new and last-resort antibiotics in DDDs per 1,000 inhabitants per day. (A) Glycylcyclines, which correspond to the ATC classification for tigecycline (J01AA12). (B) Oxazolidinones, which correspond to the ATC classifications for linezolid (J01XX08) and tedizolid (J01XX11). (C) Carbapenems, which correspond to the ATC classification for carbapenems (J01DH). (D) Polymyxins, which correspond to ATC classification for polymyxins (J01XB). Data source: IQVIA MIDAS, 2000–2015, IQVIA Inc. All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas).

Fig. 5.

Projected total global antibiotic consumption (billions of DDDs): 2000–2030. Estimated global antibiotic consumption in all countries in billions of DDDs for three scenarios: (i) all countries continue to consume at current per capita rates; (ii) consumption of all countries continues to change at current compound annual growth rates; and (iii) all countries converge to the global median antibiotic consumption rate. Estimates were produced using antibiotic use data for 2000–2015 from the IQVIA MIDAS database and World Bank DataBank population estimates and projections for 2000–2030. Data source: IQVIA MIDAS, 2000–2015, IQVIA Inc. All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas).