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[ISLAMABAD] Antibiotic consumption worldwide soared 65 per cent from 2000 to 2015, primarily driven by higher consumption of low- and middle-income countries (LMICs), particularly India and China, says a new study.
 
Published last month (26 March) in Proceedings of the National Academy of Sciences, the study relied on the IQVIA MIDAS database of 76 countries, which was built on national sample surveys of antibiotic sales, to estimate total sales of each antibiotic molecule, or combination of molecules.

“[China and India] have the largest increase because their populations are larger than other countries”

Elli Klein, John Hopkins School of Medicine

The study showed that although high income countries (HICs), led by the US, France, and Italy, showed a six per cent increase in total antibiotic use in 2000—2015, antibiotic consumption rates actually decreased by four per cent, from 26.8 defined daily doses (DDDs) to 25.7 per 1,000 inhabitants per day.  
 
Table 1. Comparison of HICs and LMICs
 
  Total Antibiotic Consumption
(2000
2015)
Antibiotic Consumption Rate
 (20002015)
High-Income Countries (HICs) 6 per cent increase
(9.7—10.3 billion DDDs)
4 per cent decrease
(25.7—26.8 DDDs per 1,000 inhabitants per day)
Low- and Middle Income Countries (LMICs) 114 per cent increase
 (11.4—24.5 billion DDDs)
77 per cent increase
 (7.6—13.5 DDDs per 1,000 inhabitants per day)
 
In contrast, antibiotic consumption during 2000—2015 in the LMICs, led by India, China, and Pakistan, increased by 114 per cent. Antibiotic consumption rate, meanwhile, rose by 77 per cent, though still half of the consumption rate of HICs.
 
The study also showed that antibiotic consumption during 2000—2015 shot up to 6.5 billion from 3.2 billion DDDs (103 per cent) in India, followed by China with a rise to 4.2 billion from 2.3 billion DDDs (79 per cent) and Pakistan with a 65 per cent rose to 1.3 billion from 0.8 billion DDDs.
 
Table 2. Top 3 LMIC Consumers
 
Country Antibiotic Consumption
(2000
2015)
Antibiotic Consumption Rate
 (20002015)
India 103 per cent increase
(3.2—6.5 billion DDDs)
63 per cent increase
(8.2—13.6 DDDs per 1,000 inhabitants per day)
China 79 per cent increase
(2.3—4.2 billion DDDs)
65 per cent increase
(5.1—8.4 DDDs per 1,000 inhabitants per day)
Pakistan 65 per cent increase
(0.8—1.3 billion DDDs)
21 per cent increase
(16.2—19.6 DDDs per 1,000 inhabitants per day
 
“Rise in country-wide incomes suggests that individuals in these countries have increased ability to purchase antibiotics,” explains Elli Klein, lead author and assistant professor of emergency medicine at the John Hopkins School of Medicine, Baltimore. “However, increased economic growth is also associated with urbanisation, which can drive the spread of infectious diseases that accelerates the demand and need for antibiotics.”
 
Klein says that in 2000, HICs, led by France, Hungary, Japan, Mexico, Singapore, Spain, New Zealand, and the US had the highest per capita daily consumption rates. This changed in 2015 when LMICs Algeria, Tunisia, and Turkey were among five countries with the highest per capita daily consumption rates.  
 
“On an overall per capita basis, Algeria, Tunisia, and Turkey have higher consumption rates than China, India and Pakistan. In fact, their rates of use are higher than most HICs, which is of great concern,” Klein tells SciDev.Net.
 
The fact that India and China are top producers of generic antibiotic drugs is not a factor behind their heightened consumptions. “They have the largest increase because their populations are larger than other countries,” explains Klein. Sarah Paulin, technical officer for antimicrobial resistance at the World Health Organization, says the WHO is working to rationalise antibiotic use while ensuring access to those who need them.
 
“WHO, together with FAO (Food and Agriculture Organization of the United Nations) and OIE (World Organisation for Animal Health), is developing a global framework for development and stewardship to combat antimicrobial resistance,” Paulin says, adding that responsible use of antibiotics across the human, animal health, and plant protection sectors, is key.  
 
This piece was produced by SciDev.Net’s Asia & Pacific desk.
 

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