Global analysis highlights antibiotic consumption trends and AMR threat

A new study highlights recent, but fluctuating, growth in global human antibiotic consumption, one of the main drivers of growing antimicrobial resistance (AMR). AMR results in infections that no longer respond to antibiotics (and other antimicrobial medicines) and often leads to longer hospital stays, higher treatment costs, and higher mortality rates. AMR is estimated to be associated with nearly five million global deaths annually.

Researchers affiliated with the One Health Trust (OHT), the Population Council, GlaxoSmithKline, the University of Zurich, the University of Brussels, Johns Hopkins University, and the Harvard T.H. Chan School of Public Health analyzed pharmaceutical sales data from 67 countries from 2016-2023 for the effects of the COVID-19 pandemic and economic growth on human antibiotic consumption. The study provides a breakdown of global antibiotic sales in reported countries by national income level, antibiotic class, and antibiotic grouping according to the World Health Organization’s (WHO) AWaRe classification system for antibiotic stewardship and projects consumption through 2030. The study is published in the Proceedings of the National Academy of Sciences (PNAS).

The study found:

• Overall antibiotic sales increased in reporting countries from 2016-2023. Antibiotic sales in 67 reporting countries increased by 16.3 percent from 2016 to 2023, from 29.5 billion defined daily doses (DDDs) to 34.3 billion DDDs. This result reflected a 10.2 percent increase in the overall consumption rate in these countries from 13.7 to 15.2 DDDs per 1,000 inhabitants per day.
• Before the COVID-19 pandemic, antibiotic consumption rates in high-income countries were decreasing, and consumption rates in middle-income countries were increasing. From 2016-2019, antibiotic consumption rates (DDDs per 1,000 inhabitants per day) increased in middle-income countries (9.8 percent) while decreasing in high-income countries (-5.8 percent).
• The COVID-19 pandemic was significantly correlated with an overall reduction in antibiotic sales, most pronounced in high-income countries. An interrupted time series analysis showed that the onset of the COVID-19 pandemic in 2020 resulted in significantly decreased antibiotic consumption rates across income groups. The decrease was most pronounced in high-income countries, with the consumption rate falling 17.8 percent from 2019 to 2020. In 2021, lower-middle-income countries led high-income countries in antibiotic consumption rates as high-income countries experienced more sustained reductions.
• Middle-income countries experienced increased Watch antibiotic sales relative to Access antibiotic sales throughout the study period. High-income countries consumed consistently higher and overall increasing levels of Access antibiotics compared to Watch antibiotics as defined by the WHO’s AWaRe system. Middle-income countries consumed consistently higher and overall increasing Watch antibiotics relative to Access antibiotics.
• Middle-income countries experienced the largest increases in antibiotic consumption rates from 2016-2023. All five of the regions with the largest increases in their antibiotic consumption rate over the study period were made up of middle-income countries.
• By 2030, global consumption is expected to increase by 52.3 percent to 75.1 billion DDDs. Global projections based on the data from 67 countries show that by 2030, antibiotic consumption is expected to increase from 49.3 billion DDDs by 52.3 percent (uncertainty range [UR]: 22.1 to 82.6 percent) to a total of 75.1 (UR: 60.2 to 90.1) billion DDDs.

This study sheds light on recent trends in consumption across country income levels that can be used to help promote the careful use of antibiotics and other public health interventions that may reduce antibiotic consumption, such as improved infection prevention and control measures and increased childhood vaccination coverage. The study also has implications for future pandemic preparedness.

According to Dr. Eili Klein, lead author of the study and Senior Fellow at OHT, “The COVID-19 pandemic temporarily disrupted antibiotic use, but global consumption has rebounded quickly and continues to rise at an alarming rate. To address this escalating crisis, we must prioritize reducing inappropriate antibiotic use in high-income nations while making substantial investments in infrastructure in low- and middle-income countries to curb disease transmission effectively.“

“Global trends in antibiotic consumption during 2016–2023 and future projections through 2030” is available in PNAS (DOI: 10.1073/pnas.2411919121).