Global antibiotic consumption and regional antimicrobial resistance, 2010–21: an analysis of pharmaceutical sales and antimicrobial resistance surveillance data

Background

The rising prevalence of antimicrobial resistance driven by inappropriate antibiotic consumption has become a major global challenge. We aimed to examine spatiotemporal patterns of antibiotic consumption across countries from 2010 to 2021 and explore factors associated with the prevalence of antibiotic resistance.

Methods

We used the latest data on antibiotic consumption from the IQVIA MIDAS database, a globally standardised system for tracking pharmaceutical sales, to characterise changes in consumption patterns of WHO Access, Watch, Reserve, and non-recommended antibiotics across 74 countries and regions during 2010–21. A linear mixed model was used to identify potential socioeconomic and environmental factors associated with antimicrobial resistance detection rate across 26 European countries for 14 bacterium–antibiotic resistance pairs, using data from the European Antimicrobial Resistance Surveillance Network.

Findings

Between 2010 and 2021, antibiotic consumption increased in most studied countries or regions in the WHO South-East Asia region (four of five), African region (three of three), region of the Americas (seven of 13, all seven in Latin America), and the Eastern Mediterranean region (five of nine). The highest annual growth rate of antibiotic consumption was found in the eight countries of west Africa (7%; formerly known as French West Africa), followed by China (7%) and Algeria (5%). Conversely, antibiotic consumption decreased in most countries in the WHO European region (25 of 33) and the Western Pacific region (nine of 11). In 2011, amoxicillin was the most used antibiotic (28%), followed by azithromycin (10%) and doxycycline (10%). The linear mixed model revealed that, among the 26 countries, antimicrobial resistance was positively associated with both antibiotic consumption rate and annual average temperature, while being negatively associated with GDP per capita and proportion of current health expenditure.

Interpretation

The global use of antibiotics has substantially changed in the past decade, with more countries meeting the WHO target for Access antibiotics. Increasing antibiotic consumption in the WHO South-East Asia and African regions and its impact on antibiotic resistance warrant close monitoring. Policies on expanding health expenditures to promote appropriate use of antibiotics should be encouraged.