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Global antibiotic consumption increases 65% over 16 years
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Researchers investigating global trends in antibiotic use reported a 65% increase from 2000 to 2015 that was largely driven by rising consumption in low- and middle-income countries.
“A large portion of increasing consumption in low- and middle-income countries (LMICs) is due to economic growth, which in many ways is actually a great thing. It means that in many of these countries, which have a higher burden of infectious diseases that can be effectively treated with antibiotics, people are getting access to those drugs,” Eili Y. Klein, PhD, fellow at the Center for Disease Dynamics, Economics & Policy (CDDEP) and assistant professor of emergency medicine at Johns Hopkins University, told Infectious Disease News. “However, rates have actually gone up and above what they are in some high-income countries, suggesting that in at least some LMICs, inappropriate use is a problem.”
Klein and colleagues used a global database of pharmaceutical sales to estimate antibiotic consumption rates in 76 countries. Total antibiotic use, they found, increased from 21.1 billion defined daily doses (DDDs) in 2000 to 34.8 billion DDDs in 2015. Meanwhile, the overall rate of consumption grew 39% from 11.3 DDDs to 15.7 DDDs per 1,000 inhabitants per day.
In LMICs, antibiotic consumption increased 114% overall and 77% per 1,000 inhabitants per day, correlating with a rise in gross domestic product per capita (P = .004). In contrast, there was a 4% decline in the rate of consumption in high-income countries, where social norms regarding prescribing practices are likely driving overuse, according to the researchers.
Additional data showed a 56% increase in the rate of broad-spectrum penicillins consumed in LMICs and a 15% increase in high-income countries between 2000 and 2015. In addition, consumption rates of cephalosporins, quinolones and macrolides substantially increased in LMICs by 399%, 125% and 119%, respectively.
“We think a large part of that is due to the use of second-line drugs as first-line therapy,” Klein said.
A rapid surge in the consumption of newer and last-resort antibiotics, including glycylcyclines, oxazolidinones, carbapenems and polymyxins, was observed in all income groups. Although the United States was initially the largest consumer of glycylcyclines and oxazolidinones, consumption rates began to decline in the country in 2009. By the end of the study period, oxazolidinone consumption was higher in India and glycylcycline consumption was higher in Taiwan, Italy, Turkey and Austria than in the U.S.
The researchers warned that increasing use of newer drugs will shorten their duration of effectiveness, highlighting the need for “radical rethinking of policies to reduce consumption.” If current trends are left unchecked, global antibiotic consumption is projected to increase 202% to 128 billion DDDs by 2030.
“Increasing use and convergence between high-income countries and low-income countries will speed up the rate at which we move toward a post-antibiotic world,” Klein noted. “A lot of work and money has been spent trying to develop new drugs, which we certainly do need, but I think conserving drugs could be a more cost-effective means of extending the life span of effective antibiotics that we have now.”
Klein said that investing in countries’ infrastructures to improve water and sanitation could “go a long way” in reducing preventable diseases and, subsequently, antibiotic consumption. New vaccines for bacterial diseases as well as viral infections that affect the upper respiratory tract, often resulting in inappropriate antibiotic use, will also play a role. In addition, investments in cleaner air may avert acute respiratory distress and conditions that require antibiotics, and a better understanding of prescribing behaviors in high-income countries, where misuse is often problematic, could help policymakers develop strategies to prevent overuse in LMICs.
“The big takeaway from this paper is that while the big growth in overall use globally is driven largely by LMICs, most LMICs still have rates of per capita use that are below that of high-income countries,” Klein said. “What we want to do is safely and effectively reduce consumption globally but still increase access in many of these LMICs. That’s the true balancing act. We don’t want LMICs to fall into the same trap of high-income countries and overuse antibiotics.” – by Stephanie Viguers
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Overuse of antibiotics is one of the world’s most serious public health problems. Currently, travel from the U.S. to regions with high antibiotic use is associated with high rates of antibiotic resistance among intestinal bacterial strains in travelers that later can complicate treatment of infection. This antibiotic resistance can persist for a year and spread to family members. The problem should be tackled by international governments. We are not developing drugs quickly enough to counteract this widespread abuse that affects all societies.
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