A new study by the Center for Disease Dynamics, Economics & Policy (CDDEP), Princeton University, ETH Zurich and the University of Antwerp analysed human antibiotic consumption in 76 countries and found it has increased worldwide from 11.3 to 15.7 defined daily doses (DDDs) per 1,000 inhabitants per day between 2000 and 2015.
In addition, when antibiotic resistance emerges in one place, it quickly spreads to other parts of the world. The study underscores the need for consistent global surveillance of antibiotic resistance and policies to curtail unnecessary antibiotic usage.
Loss of effective antibiotics is driven in large part by antibiotic consumption, most of which is inappropriate and does nothing to improve health. However, while reducing antibiotic use is critical, increasing access to antibiotics in lower-income countries is also necessary, as these countries suffer from the highest rates of illness and death caused by infectious disease, the study researchers pointed out.
“South Africa has a unique challenge in that it suffers from a quadruple burden of drug resistant infectious diseases; HIV, tuberculosis, malaria and antimicrobial resistance,” says Dr Yogan Pillay, acting director general for the South African National Department of Health. “Balancing access to life-saving antibiotics whilst curbing inappropriate use are daily challenges in our healthcare settings.”
“South Africa’s levels of antibiotic use are sky-high, with almost 100% increase between 2000-2015 and this is the driving force behind the devastating increase in common bacterial infections that are resistant to the antibiotics in this country,” says Professor Marc Mendelson, chair of the Ministerial Advisory Committee on Antimicrobial Resistance for South Africa.
“Turning the tide on resistance will require partnership between all members of the public, prescribers and the government to change our behaviour. Withholding antibiotics for symptoms and illnesses where they are not needed, coupled with reducing the need for an antibiotic in the first place by vaccinating our children, improving access to clean water and safe sanitation and ensuring good hand hygiene in our health care facilities and in the home, are major interventions that we all need to share in,”
Major study findings include:
Despite the rising rates of antibiotic use worldwide, the results suggest that reducing antibiotic consumption is possible. Consumption in high-income countries actually fell slightly over the study period. In addition, the considerable variation in per capita use across high-income countries suggests that there are lessons to be learned.
CDDEP director and study co-author Ramanan Laxminarayan noted that more than a year has passed since the United Nations General Assembly recognised the global threat of antibiotic resistance, yet little action has been taken since then.
“We must act decisively and we must act now, in a comprehensive manner, to preserve antibiotic effectiveness,” he said. “That includes making solutions that reduce consumption, such as vaccines or infrastructure improvements, a major plank of efforts to combat antibiotic resistance, particularly in low-income and middle-income countries that need access to these drugs.”