Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications from ESAC-Net and WHO Europe

Abstract

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014-2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014-2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.

Keywords: AWaRe classification; Central Asia; Eastern Europe; European Surveillance of Antibiotic Consumption Network; antibiotic utilization; antimicrobial medicines consumption; cross-national comparative study; drug utilization 75%.

FIGURE 1

Total consumption of antibacterials for systemic use (ATC J01) expressed in DDD per 1000 inhabitants per day, by pharmacological subgroup, 2018. *Member of the WHO Europe AMC Network. EU/EEA: population-weighted mean for countries of ESAC‐Net. WHO/AMC: population-weighted mean for countries of the WHO Europe AMC Network. ^†Countries reported only community data.

FIGURE 2

Total consumption of antibacterials for systemic use (ATC J01) (expressed as DDD per 1 000 inhabitants per day) for countries of ESAC‐Net and the WHO/Euro AMC Network, 2018. Austria, Iceland and Germany reported only community data.

FIGURE 3

Patterns of consumption of antibacterials according to the AWaRe classification of antimicrobial agents, 2018. AWaRe: Access, Watch and Reserve classification of antimicrobials (World Health Organization 2019). EU/EEA: population-weighted mean for countries of ESAC-Net. WHO/AMC: population-weighted mean for countries of the WHO Europe AMC Network. ^#Agents included in this analysis: antibacterials for systemic use (J01), neomycin (A07AA01), streptomycin 461 (A07AA04), polymyxin B (A07AA05), kanamycin (A07AA08), vancomycin (A07AA09), colistin 462 (A07AA10), rifamixin (A07AA11), rifampicin (J04AB02), rifamycin (J04AB03), rifabutin (J04AB04), 463 metronidazole (P01AB01). ^§Countries for which hospital sector data were not included.