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Policy  –  Elements of a plan

Monitor antibiotic consumption

Tracking antibiotic consumption within a country is an important component of a national action plan.

The quantity of consumption can be measured at many different levels, for example at country, region, hospital/prescriber or farm level. It allows for informed decisions on where to focus efforts to reduce unnecessary use and can assist evaluation of initiatives. Information on antibiotic consumption at the national level is valuable when formulating policies, developing formulary controls, or making decisions on prescribing guidelines or guidelines for prudent use in animals. Consumption data is further useful for benchmarking purposes and comparison between countries/regions/hospitals/farms.

Sources for data

A country’s total consumption can be measured as the value of its production plus imports minus the value of its exports . The following sources can be used to obtain information on antibiotic consumption:

  • Total national imports
  • National medicine agency procurement records
  • Reimbursement data from insurance companies
  • Drug importers, customs services and port authorities (during clearing processes)
  • Drug sales volume from local manufacturers and wholesalers
  • Point prevalence data on antibiotic consumption collected at health care or farm level 

In many countries there are national mechanisms to track antibiotic production or import, but when such systems are lacking, drug wholesalers become a vital source of information on consumption. Often wholesalers are the only legal entity authorized to import antibiotics. Precise estimates on the quantity of antibiotics in circulation can be challenging to obtain as it is difficult to capture data on antibiotics entering the country through informal or illegal routes.

Sales data on medicines are often kept by government agencies responsible for pharmaceuticals. The focus is often financial, but accurate volume data may be associated. For instance European countries that report consumption data to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) provide national sales and/or reimbursement data from health insurance systems. In other countries, volume data can be obtained from drug regulatory agencies responsible for which antibiotics have been registered in their jurisdiction.

For information on how to measure antibiotic consumption in health care, community and in the animal sector, see MEASURE: Consumption. How to examine if the correct antibiotic is used for the correct indication is described in MEASURE: Appropriate use.

Resources below have been sorted into the following tables:

  • General (mainly human sector)
  • Animals and integrated surveillance

Selected Resources

General

Resources Description
WHO methodology for a global programme on surveillance of antimicrobial consumption (PDF, 1MB) Methodology from WHO describing surveillance of antimicrobial consumption; How to collect data, what data to collect and how to manage data. Additional tools and resources as well as this manual in French are available at the WHO – Surveillance of Antimicrobial Use page.
WHO Report on Surveillance of Antibiotic Consumption – 2016 – 2018 Early implementation Report from WHO presenting data from 2015 on the consumption of systemic antibiotics from 65 countries and areas. It describes the WHO methodology for data collection, including challenges and future steps in monitoring antimicrobial consumption. Annex 2 describes strengths and limitations of different data sources.
Antimicrobial consumption interactive database: ESAC-Net Database. The ESAC database was developed and is maintained by the European Centers for Disease Prevention and Control (ECDC). It contains data on antimicrobial consumption that member states report annually. The database is interactive and can be accessed free of charge.
Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data Journal article. This Lancet paper provides an overview and discussion of global antibiotic consumption between 2000 and 2010. An increase in consumption of 35% is reported, with large increases in consumption of antibiotics of last resort.
Antimicrobial Medicines Consumption (AMC) Network. AMC data 2011–2014 (2017) Report presenting and analysing data on antimicrobial medicines consumption collected from non-European Union countries in the WHO European Region and Kosovo. It aims to support countries that are building or strengthening their national surveillance systems on AMC and to stimulate the sharing of data both within and between countries.
Medicine management in health care delivery Tools and case studies. Find here a set of tools developed by WHO South East Asia Regional Office for conducting a situation analysis for the national management of medicines, including antibiotics, in LMICs. The website also contains the result of situation analyses based on the WHO template that were carried out across South East Asian countries.
Antimicrobial Resistance in the Western Pacific Region: A Review of Surveillance and Health Systems Response Review by WHO of the current response to antimicrobial resistance across WHO’s Western Pacific Region. Focuses on surveillance, monitoring of use and region-specific challenges of health systems in responding to antimicrobial resistance.

Animals and integrated surveillance

Resources Description
OIE Antimicrobial Resistance Information portal with information and resources from OIE. Contains the Annual report on Antimicrobial Agents Intended for Use in Animals (PDF, 2.8 MB), a template for reporting data to the global database (Excel spreadsheet, 0.3 MB) and an annex to assist in calculations (PDF, 0.4 MB).
Integrated surveillance of antimicrobial resistance in foodborne bacteria: Application of a One Health approach Guidance developed by WHO AGISAR that provides the basic information countries need to establish a program for integrated surveillance of both antimicrobial resistance and antibiotic use.
European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) ESVAC is a project within the European Medicines Agency which collects information on how antimicrobial medicines are used in animals across the European Union (EU). A report on national sales data of antibiotics is published annually. ESVAC also provides an interactive database, sales data collection form and protocols.
Combating antibiotic Resistance: A Policy Roadmap to Reduce Use of Medically Important Antibiotics in Livestock Policy roadmap with 11 core policy recommendations aimed at a broad set of stakeholders: policymakers, food companies, institutional food purchasers (i.e. hospitals, schools and universities), and medical groups. The recommendations are divided into three key areas: 1) decreasing livestock use of medically important antibiotics; 2) monitoring livestock antibiotic use, and 3) enhancing surveillance and data integration to inform antibiotic resistance policy
1.
World Organization for Animal Health - OIE. OIE Template [Internet]. [cited 2019 May 10]. Available from: http://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/AMR/A_AMUse_Template_2018.xls
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Antimicrobials: OIE - World Organisation for Animal Health [Internet]. [cited 2019 May 10]. Available from: http://www.oie.int/scientific-expertise/veterinary-products/antimicrobials/
1.
World Organisation for animal health - OIE. The Third OIE Annual Report on Antimicrobial Agents Intended for Use in Animals [Internet]. 2018. Available from: http://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/AMR/A_Third_Annual_Report_AMR.pdf
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European Surveillance of Veterinary Antimicrobial Consumption - ESVAC. European Surveillance of Veterinary Antimicrobial Consumption [Internet]. [cited 2015 Apr 18]. Available from: https://www.ema.europa.eu/en/veterinary-regulatory/overview/antimicrobial-resistance/european-surveillance-veterinary-antimicrobial-consumption-esvac
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WHO | WHO Report on Surveillance of Antibiotic Consumption [Internet]. WHO. [cited 2018 Nov 13]. Available from: http://www.who.int/medicines/areas/rational_use/oms-amr-amc-report-2016-2018/en/
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U.S. Policy Roadmap To Reduce Use of Antibiotics in Livestock | Antibiotic Resistance Action Center [Internet]. [cited 2017 Aug 30]. Available from: http://battlesuperbugs.com/PolicyRoadmap
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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. Antimicrobial Medicines Consumption (AMC) Network. AMC data 2011–2014 (2017) [Internet]. 2017 [cited 2017 May 29]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/health-technologies-and-medicines/publications/2017/antimicrobial-medicines-consumption-amc-network.-amc-data-20112014-2017
1.
World Health Organization - WHO. WHO methodology for a global programme on surveillance of antimicrobial consumption [Internet]. [cited 2017 Mar 21]. Available from: http://www.who.int/medicines/areas/rational_use/WHO_AMCsurveillance_1.0.pdf?ua=1
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Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC) - Value of a Point-Prevalence Survey of Antimicrobial Use Across Europe. Drugs [Internet]. 2012 Nov 18 [cited 2016 Mar 14];71(6):745–55. Available from: http://link.springer.com/article/10.2165/11591180-000000000-00000
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World Health Organization, Regional Office for South East Asia. Medicine management in health care delivery: Country Situational Analysis Workbook Tool [Internet]. New Delhi, India: World Health Organization, Regional Office for South East Asia; 2016 Mar. Available from: http://www.searo.who.int/entity/medicines/country_situational_analysis/en/
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World Health Organization - WHO. Integrated surveillance of antimicrobial resistance: Guidance from a WHO Advisory Group [Internet]. 2013 [cited 2016 Feb 25]. Available from: http://www.who.int/foodsafety/publications/agisar_guidance/en/
1.
Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis [Internet]. 2014 Aug;14(8):742–50. Available from: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)70780-7/abstract
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World Health Organization - WHO. The world medicine situation [Internet]. World medicine situation. 2015 [cited 2015 Apr 15]. Available from: http://apps.who.int/medicinedocs/en/d/Js6160e/6.html#Js6160e.6
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World Health Organization - WHO. Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response [Internet]. Geneva, Switzerland: World Health Organization; 2015 [cited 2015 Apr 20]. Available from: http://www.wpro.who.int/entity/drug_resistance/resources/en/
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Methodology WIWG for DS, Methodology WCC for DS, Services WCC for DUR and CP. Introduction to drug utilization research. 2003 [cited 2015 Apr 15]; Available from: http://apps.who.int//iris/handle/10665/42627
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European Centre for Disease Prevention and Control - ECDC. Antimicrobial consumption interactive database (ESAC-Net) [Internet]. Antimicrobial Resistance. 2014 [cited 2015 Jan 30]. Available from: http://www.ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/esac-net-database/Pages/database.aspx
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European Centre for Disease Prevention and Control - ECDC. surveillance of antimicrobial consumption report [Internet]. Surveillance report. 2010 [cited 2015 Apr 17]. Available from: http://ecdc.europa.eu/en/publications/publications/antimicrobial-antibiotic-consumption-esac-report-2010-data.pdf