Consumption of antibiotics with higher potential for resistance increases 91%
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The consumption of a group of first- and second-line antibiotics with a higher potential for resistance increased by approximately 91% between 2000 and 2015, according to a study in The Lancet Infectious Diseases.
The bulk of the increase came in low- and middle-income countries, researchers reported.
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Since 2017, WHO has classified antibiotics based on resistance potential, explained Eili Y. Klein, PhD, MA, senior fellow at the Center for Disease Dynamics, Economics and Policy. The Access, Watch, Reserve (AWaRe) classification is comprised of three stewardship groups — antibiotics that should be available at all times (“access”), first- or second-choice drugs that have a higher potential for resistance and should be used sparingly (“watch”), and last-resort antibiotics and new-generation cephalosporins (“reserve”).
“This framework is intended as a tool to assess in a generalized manner the effectiveness of antibiotic stewardship at the country level,” Klein told Healio. “Given that antibiotic consumption per capita increased nearly 40% worldwide between 2000 and 2015, the goal was to assess the changes in use over time to understand how use of watch and access antibiotics have changed.”
Klein and colleagues assessed consumption of AWaRe antibiotics in 76 countries between 2000 and 2015, using quarterly national sample survey data. According to the study, they measured the proportion of antibiotic use by category and determined the ratio of Access antibiotics to Watch antibiotics for each country.
The results demonstrated that consumption of Watch antibiotics increased 90.9% (from 3.3 to 6.3 defined daily doses per 1,000 inhabitants per day, or DIDs) driven primarily by low- and middle-income countries. Among these countries, there was an increase of 165% (from 2 to 5.3 DIDs) compared with a 27.9% increase (from 6.1 to 7.8 DIDs) in high-income countries. According to Klein, this led to a significant reduction in the proportion of countries that met the WHO national-level target of at least 60% of a country’s total antibiotic consumption comprising Access antibiotics.
“Without policy changes, the relative use of Watch antibiotics is likely to increase, particularly in” low- and middle-income countries, Klein said. “Many of these therapies are critical for treatment of infections — and increased use, particularly inappropriate use, can lead to increased resistance abrogating the long-term effectiveness of these drugs.”
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