Global antibiotic consumption has increased significantly since 2016, study shows

A new study highlights the recent but unsustainable increase in global human antibiotic consumption, a major driver of antimicrobial resistance (AMR). AMR results in infections that no longer respond to antibiotics (and other antimicrobials), often resulting in longer hospital stays, higher treatment costs, and higher mortality rates. Estimates suggest that AMR is associated with nearly five million deaths worldwide each year.

Researchers affiliated with the One Health Trust (OHT), the Population Council, GlaxoSmithKline, the University of Zurich, the University of Brussels, Johns Hopkins University and the Harvard T. H. Chan School of Public Health analyzed pharmaceutical sales data from 67 countries between 2016 and 2023 to examine the impact of the COVID-19 pandemic and economic growth on antibiotic consumption.

The study presents an analysis of global antibiotic sales in the countries included in the report by national income level, antibiotic class, and the World Health Organization (WHO) AWaRe classification of antibiotics for antibiotic stewardship. It also provides a consumption forecast to 2030.

The study was published in the journal Proceedings of the National Academy of Sciences.

Key findings of the study:

• Overall antibiotic sales increased in countries reporting data between 2016 and 2023. In these 67 countries, sales increased by 16.3%, from 29.5 billion defined daily doses (DDD) to 34.3 billion DDD. This reflected a 10.2% increase in overall consumption, from 13.7 to 15.2 DDD per 1000 inhabitants per day.
• Before the COVID-19 pandemic, antibiotic consumption rates were declining in high-income countries and increasing in middle-income countries. Between 2016 and 2019, antibiotic consumption rates (DDD per 1000 inhabitants per day) increased by 9.8% in middle-income countries, while they decreased by 5.8% in high-income countries.
• The COVID-19 pandemic has been significantly associated with an overall decline in antibiotic sales, most pronounced in high-income countries. An interrupted time series analysis showed that in 2020, the onset of the pandemic led to a significant decline in antibiotic consumption across all income groups. The largest decline was in high-income countries, with consumption falling by 17.8% from 2019 to 2020. In 2021, antibiotic consumption in low- and middle-income countries exceeded that in high-income countries, as the decline lasted longer in the latter.
• In middle-income countries, sales of Watch antibiotics increased relative to Access antibiotics throughout the study period. High-income countries consistently consumed more Access antibiotics relative to Watch, while Watch antibiotics predominated in middle-income countries.
• The largest increases in antibiotic consumption between 2016 and 2023 were observed in middle-income countries. The five regions with the largest increases in antibiotic consumption were all in middle-income countries.
• By 2030, global consumption is expected to increase by 52.3% to 75.1 billion DDD. Global projections based on data from 67 countries show that by 2030, consumption will increase from 49.3 billion DDD by 52.3% (uncertainty range [UR]: 22.1–82.6%) to 75.1 (UR: 60.2–90.1) billion DDD.

This study sheds light on recent trends in antibiotic consumption by country income level, which may be useful for promoting the prudent use of antibiotics and other public health measures, such as improving infection prevention and increasing childhood vaccination coverage. The study also has important implications for preparing for future pandemics.

According to Dr. Eili Kline, lead author of the study and a senior researcher at OHT, “The COVID-19 pandemic temporarily disrupted antibiotic use, but global consumption quickly recovered and continues to grow at an alarming rate. To address this crisis, we must prioritize reducing inappropriate antibiotic use in high-income countries and invest significantly in low- and middle-income country infrastructure to effectively contain the spread of disease.”