July 09, 2014
WASHINGTON, D.C. – Human consumption of antibiotics around the globe increased by 36% in the 2000-2010 period, primarily in the developing world, raising concerns about the threat of antimicrobial resistance, according to a study by researchers from the Center for Disease Dynamics, Economics & Policy (CDDEP) and Princeton University. Antibiotic consumption both necessary and unnecessary leads directly to resistance.
This paper breaks new ground with the comparative antibiotic consumption data by country of the first decade of the 21st Century, said Dame Sally Davies, Chief Medical Officer for England, Chief Scientific Advisor for the UK Department of Health, and Chair of the Scientific Advisory Group on Antimicrobial Resistance for the World Health Organization.
The study, published on July 10th in The Lancet Infectious Diseases, evaluated trends in antibiotic consumption across 71 countries, using a global database that tracks antibiotic sales.
Between 2000 and 2010, antibiotic consumption increased by 36% overall in the countries included. The largest absolute increases were seen in cephalosporins, broad-spectrum penicillins, and fluoroquinolones. A number of antibiotic classes also saw considerable relative increases in consumption. Monobactam use increased by a factor of 20, glycopeptide use more than tripled, cephalosporin use doubled, and fluoroquinolone use increased by two-thirds over the same period.
The BRICS countries Brazil, Russia, India, China and South Africa accounted for 76% of the global increase in antibiotic consumption, though their combined population increase accounted for just 33% of the global population increase in that period. Economic growth and higher levels of healthcare spending, for instance, have led to increased access to antimicrobials among these populations.
These antibiotics are our last line of defense against increasingly resistant bacteria, said Ramanan Laxminarayan, the director of Washington, DC-based research organization CDDEP, a research scholar at Princeton University, and one of the study s authors. Antibiotic effectiveness is a valuable global resource that we cannot afford to waste. Policy changes in BRICS countries to conserve antibiotic effectiveness are essential to solving the problem.
Particularly troubling is the rise in consumption of last-resort antibiotics drugs meant to be used when all other treatment options have failed. The study showed that consumption rates of carbapenems and polymixins increased by 45% and 13%, respectively.
The indiscriminate use and sale of antibiotics often over the counter, without a confirmed infection is a problem in many low- and middle-income countries. Many developing countries have yet to establish national surveillance programs to consistently monitor the sale and use of antibiotics and the emergence of resistant strains of bacteria, CDDEP Fellow Sumanth Gandra said. In addition to better surveillance, laws restricting over-the-counter sales of antibiotics and establishment of antimicrobial stewardship programs in healthcare settings will be necessary to better control the inappropriate use of these invaluable drugs.
The analysis also reveals a wide range of per capita consumption of these vital medicines in high-income countries. U.S. per capita consumption is twice as high as it is in India and three times as high as in China. The authors cite the need for more stringent guidelines to reduce the inappropriate use of antibiotics around the globe if the spread of antibiotic-resistant bacteria is to be reined in. For low- and middle-income countries, this could include stricter enforcement of laws preventing over-the-counter sales of antibiotics. Meanwhile, all countries should place a greater emphasis on building proper surveillance infrastructure, as well as educating doctors and patients alike on the appropriate use of antimicrobials.
There is a direct relationship between consumption and development of antibiotic resistance, so the data is key for us all developing National Action Plans against Antimicrobial Resistance as set out in the World Health Assembly Resolution this May, Davies said.
The study was conducted as part of the work of the Global Antibiotic Resistance Partnership, which aims to develop actionable policy proposals on antibiotic resistance in low- and middle-income countries.
The study can be accessed at this link after 00:01 BST on July 10, 2014: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)70780-7/abstract
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