Global increases in antibiotic consumption: a concerning trend for WHO targets

• Published in: The Lancet infectious diseases Vol. 21; no. 1; pp. 10 - 11
• Main Authors: Roberts, Scott C, Zembower, Teresa R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.01.2021; Elsevier Limited
• Subjects: Amoxicillin; Ampicillin; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial activity; Antimicrobial agents; Ceftriaxone; Consumption; Drug Prescriptions; Drug resistance; Drug Utilization; High income; Humans; Income; Infections; Infectious diseases; Low income groups; Multidrug resistance; Multidrug resistant organisms; Organisms; Pharmaceutical Preparations; Sulbactam; Thorax; Trends; World Health Organization; β Lactamase
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(20)30456-4

Eili Klein and colleagues2 did a systematic evaluation of antibiotic consumption according to the WHO AWaRe Classification Database across 76 countries from 2000 to 2015.3 This study provides valuable insight into antibiotic prescribing trends at a global level. Infections with extended-spectrum β-lactamase-producing pathogens, necessitating treatment with Watch antibiotics or Reserve antibiotics, for example, have more than doubled between 2002 and 2011 in Asia and the Middle East, and might account in part for the decreasing access-to-watch ratios observed in low-income and middle-income countries.4 Even within high-income countries, multidrug-resistant organism rates are increasing; in one region of the USA, the incidence of infection with extended-spectrum β-lactamase-producing organisms doubled from 11·1 to 22·1 infections per 100 000 patient days between 2009 and 2014.5 Despite the increasing rates of these organisms in high-income countries, absolute Watch antibiotic consumption has reassuringly decreased in several high-income countries, providing credence to the utility of antimicrobial stewardship practices on a national level. Amoxicillin is not recommended as a first-line or second-line therapy according to the most recent Infectious Diseases Society of America and American Thoracic Society guidelines.6 Furthermore, the two recommended first-line treatments, ceftriaxone and ampicillin-sulbactam, have nearly identical spectrums of antimicrobial activity, yet are listed in different AWaRe classes: ceftriaxone is a Watch antibiotic and ampicillin-sulbactam is an Access antibiotic.