The post-pandemic rebound in antibiotic consumption, particularly in middle-income countries, raises concerns about antimicrobial resistance and global health challenges.

Study: Global trends in antibiotic consumption between 2016 and 2023 and future projections until 2030. Image Credit: Saiful52/Shutterstock.com

In a recent study published in Proceedings of the National Academy of Sciencesa group of researchers analyzed antibiotic consumption trends (2016-2023), impacts of coronavirus disease 2019 (COVID-19), and economic growth, and project their future use to guide antimicrobial resistance policies .

Background

Antibiotic resistance is an urgent global health challenge, contributing to nearly 5 million deaths in 2019, with the highest mortality rates in low-income countries despite lower consumption.

Resistance results from overuse in humans, agriculture and animals and poor infection control. Antibiotic consumption increased by 65% ​​between 2000 and 2015, driven by economic growth in lower-middle-income countries (LMICs), while high-income countries (HICs) maintain higher per capita rates. students.

Overreliance on antibiotics, especially when in need of improved sanitation, increases resistance. Monitoring antibiotic use is essential to adapt policies and address disparities. Additional research is needed to connect consumer trends to resilience and outcomes.

About the study

Data was retrieved for 67 countries using the IQVIA Medical Information Data Analysis System (MIDAS) database, which provides sales estimates for pharmaceutical drugs. IQVIA MIDAS compiles monthly data from pharmacies and other points of sale, categorizing consumption by retail and hospital sectors.

Antibiotic amounts were measured in kilograms of active ingredients and converted to defined daily doses (DDD) using the World Health Organization’s Anatomical Therapeutic Chemical (ATC/DDD) classification system ( WHO). Antibiotics in the hospital sector were assumed to be administered intravenously, while antibiotics in the retail sector were considered to be administered orally.

DDD values ​​for combination drugs were calculated by separating and analyzing individual molecules, and estimates were derived from additional sources for molecules lacking defined DDDs.

Population data from the World Bank and national governments were used to calculate DDD consumption rates per 1,000 people per day. Countries were grouped according to the World Bank’s 2023 income classification: LMICs, upper-middle-income countries (MICs), and HICs.

Antibiotics were then classified using the WHO AWaRe (Access and Watch) framework. Interrupted time series analyzes (ITSA) assessed the impact of the COVID-19 pandemic on consumption, while global usage projections through 2030 were generated using extrapolations and sensitivity analyses. Data cleaning and visualization were carried out using Stata, R and Excel.

Study results

Between 2016 and 2023, total antibiotic consumption in the 67 countries with available data increased by 16.3%, from 29.5 to 34.3 billion DDD. Over the same period, the average rate of antibiotic consumption increased by 10.6%, from 13.7 to 15.2 DDD per 1,000 inhabitants per day. Notable variations were observed across income groups as defined by the World Bank.

MICs, encompassing both LMICs and LMICs, saw an 18.6% increase in consumption rates, compared to a 4.9% decrease in HICs. The COVID-19 pandemic had a marked impact, with consumption falling significantly in 2020, particularly in HICs (−17.8%), before rebounding in PRIs.

The largest percentage increases in antibiotic consumption have occurred in LMICs, particularly in LMICs like Vietnam, where rates have more than doubled, and in LMICs like Thailand and Central America . By 2023, three LMICs and three LMICs ranked among the top 10 countries in antibiotic consumption, highlighting changes in global trends.

Conversely, the countries with the largest declines during the pandemic are the Philippines and Malaysia. Recovery rates from the pandemic have varied, with MICs experiencing rapid increases, led by countries such as Indonesia, Argentina and India.

Antibiotic consumption also changed by drug class. Broad-spectrum penicillins, cephalosporins, and macrolides remain the most widely used, although usage trends differ across income groups.

At the end of the study period, PRIs exceeded HICs in macrolide and fluoroquinolone consumption rates, largely due to increased LMICs. Consumption of “last resort” antibiotics, such as carbapenems and oxazolidinones, has increased sharply in MICs, indicating emerging resistance challenges.

Differences in the use of Access and Watch antibiotics were evident. HICs consistently consumed more Access antibiotics, with an Access-to-Watch index increasing, while PRIs consumed more Watch antibiotics, particularly in LMICs. In 2023, LMICs led watch consumption, reflecting disparities in management practices.

Global antibiotic consumption in 2023, including missing data estimates, reached 49.3 billion DDD, or 17.0 DDD per 1,000 population per day, a 20.9% increase in use total since 2016.

Projections suggest that, without policy changes, global consumption could increase by 52.3% by 2030, to potentially reach 75.1 billion DDD, highlighting the urgent need for targeted interventions.

Conclusions

To summarize, between 2016 and 2023, global antibiotic consumption increased by 20.9%, a slower increase than the 35.5% increase from 2008 to 2015, with a significant decline in 2020 due to the COVID-19 pandemic.

High-income countries saw the largest reductions, influenced by public health measures, while middle-income countries rebounded quickly after the pandemic, driven by economic growth and urbanization. PRIs have also seen increasing use of last-resort antibiotics and fluoroquinolones, highlighting management gaps.

Combating these trends requires stronger regulation, equitable access and investment in preventive measures such as sanitation, vaccination and diagnostics, as well as global frameworks like WHO’s AWaRe to effectively combat antimicrobial resistance.