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Policy  –  Implement the 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

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.

For more 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. For resistance surveillance, see Surveillance of antibiotic resistance.

Resources below have been sorted into the following tables:

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

Selected Resources

General

Resources Description
GLASS methodology for surveillance of national antimicrobial consumption Document that provides an overview of the methodology for GLASS-AMC – the GLASS component on surveillance of national antimicrobial consumption, and its principles for data collection and reporting. See also the  GLASS manual on the management of antimicrobial consumption data. and GLASS guide for national surveillance systems for monitoring antimicrobial consumption in hospitals. Additional support tools, It tools and reports can be found at the WHO GLASS 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.
WHO Regional Office for Europe Antimicrobial Medicines Consumption (‎AMC)‎ Network: AMC data 2011–2017 Report presenting and analysing data on antimicrobial medicines consumption collected from non-European Union countries and areas in the WHO European Region. The AMC network aims to support countries that are building or strengthening their national surveillance systems on AMC and stimulate the sharing of data both within and between countries. 6 page executive summary can be found here.
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 last-resort antibiotics (free article, but requires registration).
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
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.
OIE Antimicrobial Resistance Information portal with information and resources from OIE. See also the Fifth OIE Annual Report on Antimicrobial Agents Intended for Use in Animals; template for reporting national data to the global database (Excel spreadsheet, 0.3 MB) and an annex to assist in calculations (PDF, 0.2 MB).
European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) Information portal. 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.
AACTING Guidelines Guidelines intended to assist establishment or revision of farm-level AMU monitoring systems. Particularly relevant for use in countries with established medicines registrations and regulations. An overview of existing monitoring systems in countries can be found here.
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.
WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. WHO https://www.who.int/publications/i/item/who-report-on-surveillance-of-antibiotic-consumption (2018).
1.
Data source overview of antimicrobial consumption. European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en/antimicrobial-consumption/database/data-source-overview (2021).
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OIE Antimicrobial resistance. OIE - World Organisation for Animal Health https://www.oie.int/en/what-we-do/global-initiatives/antimicrobial-resistance/.
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WHO Euro. WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network: AMC data 2011–2017. (World Health Organization. Regional Office for Europe, 2020).
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GLASS methodology for surveillance of national antimicrobial consumption. https://www.who.int/publications-detail-redirect/9789240012639 (2020).
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Integrated surveillance of antimicrobial resistance in foodborne bacteria: application of a one health approach: guidance from the WHO Advisory Group on Integrated Surveillanec of Antimicrobial Resistance (‎AGISAR)‎. WHO https://apps.who.int/iris/handle/10665/255747 (2017).
1.
AACTING. AACTING | Guidelines. https://aacting.org/aacting-guidelines/.
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World Health Organization - WHO. Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response. https://apps.who.int/iris/handle/10665/208222 (2015).
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European Surveillance of Veterinary Antimicrobial Consumption - ESVAC. European Surveillance of Veterinary Antimicrobial Consumption. https://www.ema.europa.eu/en/veterinary-regulatory/overview/antimicrobial-resistance/european-surveillance-veterinary-antimicrobial-consumption-esvac.
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U.S. Policy Roadmap To Reduce Use of Antibiotics in Livestock | Antibiotic Resistance Action Center. http://battlesuperbugs.com/PolicyRoadmap.
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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 71, 745–755 (2012).
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Van Boeckel, T. P. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 14, 742–750 (2014).
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World Health Organization - WHO. The world medicine situation. World medicine situation http://apps.who.int/medicinedocs/en/d/Js6160e/6.html#Js6160e.6 (2015).
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Methodology, W. I. W. G. for D. S., Methodology, W. C. C. for D. S. & Services, W. C. C. for D. U. R. and C. P. Introduction to drug utilization research. (2003).
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European Centre for Disease Prevention and Control - ECDC. Antimicrobial consumption interactive database (ESAC-Net). Antimicrobial Resistance http://www.ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/esac-net-database/Pages/database.aspx (2014).