Consumption of antibiotics in the community, European Union/European Economic Area, 1997-2017

Abstract

Objectives: Data on antibiotic consumption in the community were collected from 30 EU/EEA countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in the composition of the main antibiotic groups.

Methods: For the period 1997-2017, data on consumption of antibiotics, i.e. antibacterials for systemic use (ATC group J01), in the community, aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Antibiotic consumption was analysed based on ATC-3 groups, and presented as trends, seasonal variation, presence of change-points and compositional changes.

Results: In 2017, antibiotic consumption in the community expressed in DDD per 1000 inhabitants per day varied by a factor 3.6 between countries with the highest (Greece) and the lowest (the Netherlands) consumption. Antibiotic consumption in the EU/EEA did not change significantly over time. Antibiotic consumption showed a significant seasonal variation, which decreased over time. The number of DDD per package significantly increased over time. The proportional consumption of sulphonamides and trimethoprim (J01E) relative to other groups significantly decreased over time, while the proportional consumption of other antibacterials (J01X) relative to other groups significantly increased over time.

Conclusions: Overall, antibiotic consumption in the community in the EU/EEA did not change during 1997-2017, while seasonal variation consistently decreased over time. The number of DDD per package increased during 1997-2017.

Figure 1.

Consumption of antibiotics (ATC J01) in the community, expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day, 30 EU/EEA countries, 2017. For Czechia, 2015 data are used. For Slovakia, 2016 data are used. For Cyprus and Romania, total care data, i.e. community and hospital sector combined, are used. For Ireland, nitrofurantoin (J01XE01) consumption is not included. For Slovenia, sulphonamide and trimethoprim (J01E) consumption is not included.

Figure 2.

Consumption of antibiotics (ATC J01) in the community, expressed in packages per 1000 inhabitants per day, 20 EU/EEA countries, 2017. For Czechia, 2015 data are used. For Slovakia, 2016 data are used. For Ireland, nitrofurantoin (J01XE01) consumption is not included.

Figure 3.

Estimated trend (solid line) and linear trend (dashed line) of consumption of antibiotics (ATC J01) in the community based on quarterly data, 25 EU/EEA countries, 1997–2017. β₀, predicted consumption in the first quarter of 1997; β₁, predicted increase (if positive)/decrease (if negative) in consumption per quarter; β₂, predicted difference in slope after versus before the first change-point; β₃, predicted difference in slope after versus before the second change-point; β₄, predicted difference in slope after versus before the third change-point; β₀^S, predicted amplitude of the upward winter and downward summer peak in consumption; β₁^S, predicted increase (if positive)/decrease (if negative) of the amplitude of the upward winter and downward summer peak in consumption per quarter; δ, shift in timing of the upward winter and downward summer peak from one year to another. *Statistically significant at significance level 0.05.