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Toolbox  –  Measure

Consumption of antibiotics

Knowledge about quantity of antibiotic consumption in both humans and animals is key to guide interventions and for understanding the scale of the problem.

Consumption can be measured at several levels:

  • National
  • Regional
  • Community
  • Farm or household
  • Prescriber or provider

Antibiotic consumption may be measured as the quantity of antibiotics sold, prescribed, dispensed or consumed. It is important to consider the local disease prevalence, susceptibility patterns, antibiotic prescribing practices and over the counter availability when reviewing data. Comparisons with similar settings can help to give context.

Terminology:

In the Toolbox, we use the term consumption as an overarching term. This includes sales, prescriptions or doses taken/administered. In many cases, reported consumption data is based on sales or reimbursement data, and does not reflect the actual ingestion of drugs. When reading or writing reports, it is important to consider what has been measured.

The appropriate means of collecting data will depend on the setting. Looking at number of prescriptions or defined daily doses (DDDs) using data from existing databases may be more feasible than to measure the overall antibiotic consumption at the national level. In food animals however, it is difficult to derive DDDs across species as antibiotics may be used preventatively or as growth promoter. For information on data collection at the national level, see POLICY: Elements of a national action plan – Monitor antibiotic consumption.

Why measure antibiotic consumption?

Reliable data on sales, number of prescriptions and utilisation of antibiotics can assist in development of guidelines or when planning and evaluating efforts to improve use of antibiotics and limit the spread of resistance. Consumption data also provide the opportunity to compare consumption between different settings, for example between hospitals, between farms or between regions or countries. This section gives an overview of where data on antibiotic consumption can be obtained and ways to measure consumption in both human and food animal settings.

Selected Resources

Resources Description
Integrated surveillance of antimicrobial resistance in foodborne bacteria: Application of a One Health approach Guide designed for WHO Member States and other stakeholders for designing an integrated surveillance program. Chapter 2 covers consumption. Read more about the WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) here
ECDC, EFSA and EMA Joint Scientific Opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals Indicators: Suggestion of outcome indicators with a ‘One Health’ perspective for monitoring progress of surveillance of consumption and resistance in humans and food-producing animals, with methodology for how indicators were selected, and examples of calculation of indicators. Established by European health and food safety agencies.
ECDC/EFSA/EMA joint reports on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals (JIACRA reports) Report: Using existing data from Europe, ECDC/EFSA/EMA has made an integrated analysis of antimicrobial consumption and resistance to the same antimicrobials in bacteria from humans and animals.
A conceptual framework for the environmental surveillance of antibiotics and antibiotic resistance Journal article proposing a framework for how to use environmental samples for surveillance of antibiotic consumption and antibiotic resistance. The framework contains five objectives of surveillance together with proposed markers and sampling sites.

Further reading

1.
Huijbers PMC, Flach C-F, Larsson DGJ. A conceptual framework for the environmental surveillance of antibiotics and antibiotic resistance. Environment International [Internet]. 2019 [cited 2019 Jun 28];130:104880. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0160412019304908
1.
ECDC, EMA Committee for Medicinal Products for Veterinary Use (CVMP), EFSA Panel on Biological Hazards (BIOHAZ). ECDC, EFSA and EMA Joint Scientific Opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals. EFSA Journal [Internet]. 2017 Oct 1;15(10):n/a-n/a. Available from: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2017.5017/abstract
1.
World Health Organization Regional Office for Europe. Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR). Annual report 2017 [Internet]. 2017 [cited 2017 Dec 4]. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2017/central-asian-and-eastern-european-surveillance-of-antimicrobial-resistancecaesar.-annual-report-2017
1.
Integrated surveillance of antimicrobial resistance in foodborne bacteria: Application of a One Health approach [Internet]. WHO. [cited 2017 Jun 30]. Available from: http://www.who.int/foodsafety/publications/agisar_guidance2017/en/
1.
World Health Organization - WHO. WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) [Internet]. WHO. [cited 2016 Mar 10]. Available from: http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/agisar/en/