Antimicrobial medicines consumption in Eastern Europe and Central Asia: an updated cross-national study and assessment of quantitative metrics for policy action

Jane Robertson, Kotoji Iwamoto, Iris Hoxha, Lilith Ghazaryan, Vafa Abilova, Ana Cvijanovic, Halina Pyshnik, Marina Darakhvelidze, Larissa Makalkina, Arianit Jakupi, Aigul Dzhakubekova, Angela Carp, Lidija Cizmovic, Svetlana Ratchina, Vesela Radonjic, Alomuddin Yusufi, Mesil Askov, Muhabbat Ibragimova, Brian Godman, Hans Kluge & 1 others Hanne Bak Pedersen

Research output: Contribution to journalArticle

Abstract

Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6%, 9·4 to 28·8%, and 7·5 to 24·6% of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5% of total consumption (mean 30·9%). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0% (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.
LanguageEnglish
Article number1156
Number of pages13
JournalFrontiers in Pharmacology
Volume9
DOIs
Publication statusPublished - 5 Mar 2019

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Central Asia
Dichlorodiphenyldichloroethane
Eastern Europe
Far East
Anti-Bacterial Agents
Cephalosporins
Penicillins
Quinolones
beta-Lactams
European Union
Clinical Protocols
Guidelines

Keywords

  • antibiotic utilization
  • antimicrobial medicines consumption
  • national surveillance networks
  • cross-national comparative study
  • Eastern Europe
  • Central Asia
  • quality indicators

Cite this

Robertson, Jane ; Iwamoto, Kotoji ; Hoxha, Iris ; Ghazaryan, Lilith ; Abilova, Vafa ; Cvijanovic, Ana ; Pyshnik, Halina ; Darakhvelidze, Marina ; Makalkina, Larissa ; Jakupi, Arianit ; Dzhakubekova, Aigul ; Carp, Angela ; Cizmovic, Lidija ; Ratchina, Svetlana ; Radonjic, Vesela ; Yusufi, Alomuddin ; Askov, Mesil ; Ibragimova, Muhabbat ; Godman, Brian ; Kluge, Hans ; Pedersen, Hanne Bak. / Antimicrobial medicines consumption in Eastern Europe and Central Asia : an updated cross-national study and assessment of quantitative metrics for policy action. In: Frontiers in Pharmacology . 2019 ; Vol. 9.
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abstract = "Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6{\%}, 9·4 to 28·8{\%}, and 7·5 to 24·6{\%} of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90{\%} of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5{\%} of total consumption (mean 30·9{\%}). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0{\%} (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.",
keywords = "antibiotic utilization, antimicrobial medicines consumption, national surveillance networks, cross-national comparative study, Eastern Europe, Central Asia, quality indicators",
author = "Jane Robertson and Kotoji Iwamoto and Iris Hoxha and Lilith Ghazaryan and Vafa Abilova and Ana Cvijanovic and Halina Pyshnik and Marina Darakhvelidze and Larissa Makalkina and Arianit Jakupi and Aigul Dzhakubekova and Angela Carp and Lidija Cizmovic and Svetlana Ratchina and Vesela Radonjic and Alomuddin Yusufi and Mesil Askov and Muhabbat Ibragimova and Brian Godman and Hans Kluge and Pedersen, {Hanne Bak}",
year = "2019",
month = "3",
day = "5",
doi = "10.3389/fphar.2018.01156",
language = "English",
volume = "9",
journal = "Frontiers in Pharmacology",
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Robertson, J, Iwamoto, K, Hoxha, I, Ghazaryan, L, Abilova, V, Cvijanovic, A, Pyshnik, H, Darakhvelidze, M, Makalkina, L, Jakupi, A, Dzhakubekova, A, Carp, A, Cizmovic, L, Ratchina, S, Radonjic, V, Yusufi, A, Askov, M, Ibragimova, M, Godman, B, Kluge, H & Pedersen, HB 2019, 'Antimicrobial medicines consumption in Eastern Europe and Central Asia: an updated cross-national study and assessment of quantitative metrics for policy action' Frontiers in Pharmacology , vol. 9, 1156. https://doi.org/10.3389/fphar.2018.01156

Antimicrobial medicines consumption in Eastern Europe and Central Asia : an updated cross-national study and assessment of quantitative metrics for policy action. / Robertson, Jane; Iwamoto, Kotoji; Hoxha, Iris; Ghazaryan, Lilith; Abilova, Vafa; Cvijanovic, Ana; Pyshnik, Halina; Darakhvelidze, Marina; Makalkina, Larissa; Jakupi, Arianit; Dzhakubekova, Aigul; Carp, Angela; Cizmovic, Lidija; Ratchina, Svetlana; Radonjic, Vesela; Yusufi, Alomuddin; Askov, Mesil; Ibragimova, Muhabbat; Godman, Brian; Kluge, Hans; Pedersen, Hanne Bak.

In: Frontiers in Pharmacology , Vol. 9, 1156, 05.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antimicrobial medicines consumption in Eastern Europe and Central Asia

T2 - Frontiers in Pharmacology

AU - Robertson, Jane

AU - Iwamoto, Kotoji

AU - Hoxha, Iris

AU - Ghazaryan, Lilith

AU - Abilova, Vafa

AU - Cvijanovic, Ana

AU - Pyshnik, Halina

AU - Darakhvelidze, Marina

AU - Makalkina, Larissa

AU - Jakupi, Arianit

AU - Dzhakubekova, Aigul

AU - Carp, Angela

AU - Cizmovic, Lidija

AU - Ratchina, Svetlana

AU - Radonjic, Vesela

AU - Yusufi, Alomuddin

AU - Askov, Mesil

AU - Ibragimova, Muhabbat

AU - Godman, Brian

AU - Kluge, Hans

AU - Pedersen, Hanne Bak

PY - 2019/3/5

Y1 - 2019/3/5

N2 - Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6%, 9·4 to 28·8%, and 7·5 to 24·6% of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5% of total consumption (mean 30·9%). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0% (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

AB - Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6%, 9·4 to 28·8%, and 7·5 to 24·6% of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5% of total consumption (mean 30·9%). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0% (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

KW - antibiotic utilization

KW - antimicrobial medicines consumption

KW - national surveillance networks

KW - cross-national comparative study

KW - Eastern Europe

KW - Central Asia

KW - quality indicators

U2 - 10.3389/fphar.2018.01156

DO - 10.3389/fphar.2018.01156

M3 - Article

VL - 9

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

SN - 1663-9812

M1 - 1156

ER -