Antimicrobial Medicines Consumption in Eastern Europe and Central Asia - An Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action

Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

Robertson J.1, 2 , Iwamoto K.1 , Hoxha I.3 , Ghazaryan L.4 , Abilova V.5 , Cvijanovic A.6 , Pyshnik H.7, 8 , Darakhvelidze M.9 , Makalkina L.10 , Jakupi A.11, 12 , Dzhakubekova A.13 , Carp A.14 , Cizmovic L.15 , Rachina S. 16 , Radonjic V.17, 18 , Yusufi S.19 , Aksoy M.20 , Ibragimova M.21 , Godman B.22, 23, 24, 25 , Kluge H.1 , Pedersen H.B.1
  • 1 WHO, Reg Off Europe, Copenhagen, Denmark
  • 2 Univ Newcastle, Dept Clin Pharmacol, Callaghan, NSW, Australia
  • 3 Univ Med, Dept Pharm, Tirana, Tirana, Albania
  • 4 Minist Hlth, Sci Ctr Drug & Med Technol Expertise, Yerevan, Armenia
  • 5 Minist Hlth, Analyt Expertise Ctr, Dept Import Med & Med Devices, Baku, Azerbaijan
  • 6 Agcy Med Prod & Med Devices Bosnia & Herzegovina, Sect Providing Informat Drugs & Med Prod, Sarajevo, Bosnia & Herceg
  • 7 Minist Hlth Republ Belarus, Dept Pharmaceut Inspect, Minsk, BELARUS
  • 8 Minist Hlth Republ Belarus, Org Med Supply, Minsk, BELARUS
  • 9 Minist IDPs Labour Hlth & Social Affairs Georgia, Hlth Care Dept, Tbilisi, Georgia
  • 10 Astana Med Univ, Course Clin Pharmacol & Pharm, Dept Cardiol & Internal Med, Astana, Kazakhstan
  • 11 A2 Pharmaceut Consulting, Pristina, Kosovo
  • 12 UBT Higher Educ Inst, Pristina, Kosovo
  • 13 Minist Hlth, Dept Drug Provis & Med Devices, Specialized Expertise Med Unit, Bishkek, Kyrgyzstan
  • 14 Hlth Syst Projects, PI Coordinat Implementat & Monitoring Unit, Kishinev, Moldova
  • 15 Agcy Med & Med Devices, Dept Establishing Maximum Prices & Monitoring Con, Podgorica, Montenegro
  • 16 Russian Friendship Univ, Internal Med Dept, Cardiol & Funct Diagnost Course, Moscow, Russia
  • 17 Med & Med Devices Agcy Serbia, Natl Ctr Informat Med & Med Device, Belgrade, Serbia
  • 18 Univ Kragujevac, Fac Med Sci, Dept Pharm, Kragujevac, Serbia
  • 19 Avicenna Tajik State Med Univ, Sci, Dushanbe, Tajikistan
  • 20 Minist Hlth, Dept Rat Use Med, Turkish Med & Med Devices Agcy, Ankara, Turkey
  • 21 Minist Hlth Republ Uzbekistan, Agcy Dev Pharmaceut Ind, State Ctr Expertise & Standardizat Med Med Device, Dev Pharmaceut Ind,Informat & Analyt Dept, Tashkent, Uzbekistan
  • 22 Univ Strathclyde, Strathclyde Inst Pharm & Biomed Sci, Glasgow, Lanark, Scotland
  • 23 Univ Liverpool, Liverpool Hlth Econ, Liverpool, Merseyside, England
  • 24 Karolinska Univ Hosp Huddinge, Karolinska Inst, Div Clin Pharmacol, Stockholm, Sweden
  • 25 Sefako Makgatho Hlth Sci Univ, Sch Pharm, Dept Publ Hlth Pharm & Management, Pretoria, South Africa
Ключевые слова
antibiotic utilization; antimicrobial medicines consumption; national surveillance networks; cross-national comparative study; Eastern Europe; Central Asia; quality indicators
Дата создания
Дата изменения
Постоянная ссылка

Другие записи