By Saleem Shaikh
[ISLAMABAD] Antibiotic consumption worldwide soared by 65 per cent from 2000 to 2015, a rise driven by higher consumption in low- and middle-income countries (LMICs), particularly India and China.
According to a study published last month (26 March) in Proceedings of the National Academy of Sciences, high-income countries (HICs) — led by the US, France, and Italy — showed a six per cent increase in total antibiotic use. But antibiotic consumption rates by population actually decreased by four per cent: from 26.8 defined daily doses (DDDs) to 25.7 per 1,000 inhabitants per day.
“[China and India] have the largest increase because their populations are larger than other countries”
In contrast, total antibiotic consumption in LMICs — led by India, China, and Pakistan — increased by 114 per cent over the same 15-year period. The consumption rate, meanwhile, rose by 77 per cent. This is still half the consumption rate of HICs, which suggests that despite the rising trend in LIMCs, there is still greater use of antibiotics per person in developed countries.
The data shows that antibiotic consumption during 2000‒2015 more than doubled in India, from 3.2 to 6.5 billion DDDs (103 per cent). In China, total consumption rose to 4.2 billion from 2.3 billion DDDs (79 per cent). Pakistan saw a 65 per cent rise, from 0.8 to 1.3 billion DDDs.
Table 1. Comparison of HICs and LMICs
|Total Antibiotic Consumption
|Antibiotic Consumption Rate
|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)
The study relied on the IQVIA MIDAS database of 76 countries, which was built on national sample surveys of antibiotic sales. It estimated total sales of each antibiotic molecule, or a combination of molecules.
Table 2. Top 3 LMIC Consumers
|Antibiotic Consumption Rate
|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
“[A] 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 Johns 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 had the highest per capita daily consumption rates, led by France, Hungary, Japan, Mexico, Singapore, Spain, New Zealand, and the US. This changed in 2015 when LMICs took the lead, with Algeria, Tunisia, and Turkey 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 rising consumption. “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 it is crucial to use antibiotics responsibly across the human health, animal health, and plant protection sectors.