Global trends in antibiotic consumption during 2016-2023 and future projections through 2030

Abstract

Antibiotic resistance is a global public health threat. Many factors contribute to this issue, with human antibiotic consumption being significant among them. Analyzing trends and patterns in consumption can aid in developing policies to mitigate the burden of antimicrobial resistance and global disparities in access to antibiotics. Using pharmaceutical sales data licensed from IQVIA, we estimate national-level trends in antibiotic consumption in 67 countries during 2016-2023 and analyze the effects of economic growth and the COVID-19 pandemic. Finally, we estimate global human consumption and project growth through 2030 assuming current trends. We find that estimated antibiotic consumption in reported countries increased 16.3% from 29.5 to 34.3 billion defined daily doses (DDDs) from 2016 to 2023, reflecting a 10.6% increase in the consumption rate from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. Increases were most pronounced in upper-middle- and lower-middle-income countries. While the COVID-19 pandemic significantly reduced consumption globally, this was most pronounced in high-income countries, and in these countries, reductions in antibiotic use in 2020 were sharper, and lasted longer, than in other countries. By 2030, we project that, without reductions in rapidly developing nations, such as investments to improve infrastructure, particularly water and sanitation, along with improved access to vaccination, global antibiotic consumption will increase by 52.3% from an estimated 49.3 billion in 2023 to 75.1 billion DDDs.

Keywords: AMR; antibiotic resistance; antimicrobial resistance; global public health.

Fig. 1.

Change in global antibiotic consumption by country and country income classification, 2016–2023. (A) Yearly antibiotic consumption rate, measured in DDDs per 1,000 inhabitants per day, by country income classification. (B) Absolute change in antibiotic consumption rate between 2016 and 2023 by country in DDDs per 1,000 inhabitants per day. Countries in gray have no data in the database. Country income classifications noted as LMIC = lower-middle-income countries, MIC = middle-income countries, UMIC = upper-middle-income countries, HIC = high-income countries. Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.

Fig. 2.

Change in each antibiotic consumption rate, by country. Results are the percentage change between each country’s consumption rate in 2016–2023. Country income classifications noted as LMIC = lower-middle-income countries, UMIC = upper-middle-income countries, HIC = high-income countries. Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.

Fig. 3.

Global antibiotic consumption by antibiotic class. (A) Yearly changes in DDDs per 1,000 inhabitants per day for the top five antibiotic classes by consumption amount. All other classes were combined into other. (B) Antibiotic consumption differences between 2016 and 2023 for the top five antibiotic classes by consumption amount, with all other classes combined into other. DDD = defined daily dose. Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.

Fig. 4.

Global antibiotic consumption for the top five most consumed antibiotic classes by country income classification. Data are displayed as DDDs per 1,000 inhabitants per day. (A) BSP. (B) cephalosporins. (C) macrolides. (D) fluoroquinolones. (E) tetracyclines. Country income classifications noted as LMIC = lower-middle-income countries, MIC = middle-income countries, UMIC = upper-middle-income countries, HIC = high-income countries. Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.

Fig. 5.

Global access and watch antibiotic consumption by country income classification. We illustrate (A) the Access-to-Watch index, as well as (B) Access and (C) Watch consumption by income classification for the period 2016–2023. The Access-to-Watch index is the ratio of Access to Watch consumption each year. Consumption data are displayed as DDDs per 1,000 inhabitants per day. Country income classifications noted as LMIC = lower-middle-income countries, MIC = middle-income countries, UMIC = upper-middle-income countries, HIC = high-income countries. Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.

Fig. 6.

Estimated total global antibiotic consumption in DDD (billions). Global consumption estimates include totals for all countries in the database and use country income classification to estimate per capita use for countries not included. Per capita estimates were multiplied by each country’s estimated or forecasted population to generate estimated total. Line from 2023–2030 is the average projected change in antibiotic consumption assuming countries future rate of change is between their compounded annual growth rate from 2016 to 2019 and the rate from 2020–2023. The shaded region is the uncertainty range of the projection (includes only variance from projected rate of change). Data Source: Based on IQVIA MIDAS^® sales data for period 2016–2023. Copyright IQVIA. All rights reserved.