Analysis by community and hospital sectors

The analyses presented in sections 10.1–10.6 are based on estimates of total consumption.

Different patterns of consumption would be expected in the hospital and community sectors. Analyses by sector can provide more detailed information to support stewardship activities. Disaggregated data for Kazakhstan for 2015–2017 are presented in this report.

10�7�1 Consumption of antibacterials for systemic use (J01) in community and hospital sectors by route of administration

The consumption of oral and parenteral (injectable) formulations of J01 antibacterials is shown in Fig. 10.13 (community consumption) and Fig. 10.14 (hospital consumption), and is summarized in Table 10.11.

DDD/1000 inhabitants per day

KAZ 2015 KAZ

2016 KAZ 2017 0

5 10 15

Parenteral antibacterials Oral antibacterials

DDD/1000 inhabitants per day

KAZ 2015 KAZ

2016 KAZ 2017 0

5 10 15

Parenteral antibacterials Oral antibacterials

Fig. 10.13 Community consumption of J01 antibacterials by route of administration

Fig. 10.14 Hospital consumption of J01 antibacterials by route of administration

Table 10.11 Community and hospital consumption of J01 antibacterials by route of administration

Route of administration

DDD/1 000 inhabitants per day^a (% of total^b)

Community consumption Hospital consumption

2015 2016 2017 2015 2016 2017

Oral J01 9.6 (82) 9.8 (80) 9.8 (79) 1.5 (48) 1.8 (55) 1.5 (48)

Parenteral J01 2.1 (18) 2.5 (20) 2.6 (21) 1.6 (52) 1.5 (45) 1.7 (52)

Total 11.7 12.2 12.4 3.2 3.4 3.2

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

Community consumption represented 79% of total J01 consumption in 2017, at 12.4 DID in the community sector and 3.2 DID in the hospital sector.

Oral consumption dominated in the community sector, at 79% oral and 21% parenteral consumption in 2017. Hospital consumption slightly favoured parenteral forms, at 52% of hospital consumption in 2017.

10�7�2 Consumption of antibacterials for systemic use (J01) in community and hospital sectors by pharmacological subgroup

The consumption of the pharmacological subgroups of J01 antibacterials is shown in Fig. 10.15 (community consumption) and Fig. 10.16 (hospital consumption), and is summarized in Table 10.12.

DDD/1000 inhabitants per day

KAZ

DDD/1000 inhabitants per day

KAZ

Fig. 10.15 Community consumption of J01 antibacterials by pharmacological subgroup

Fig. 10.16 Hospital consumption of J01 antibacterials by pharmacological subgroup

Table 10.12 Absolute and relative consumption of J01 antibacterials by pharmacological subgroup

Pharmacological subgroup

DDD/1 000 inhabitants per day^a (% of total^b)

Community consumption Hospital consumption

2015 2016 2017 2015 2016 2017

Tetracyclines (J01A) 1.3 Other beta-lactams (includes

cephalosporins) (J01D) 1.4 Sulfonamides and trimethoprim

(J01E)

Macrolides, lincosamides and streptogramins (J01F) Quinolone antibacterials (J01M) 1.8

(15.4) 1.9 Other J01 antibacterials (J01G,

J01R, J01X) 1.1

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

Patterns of consumption were completely different in the community and hospital sectors. Beta-lactams (J01C) represented 30.6% of consumption in the community sector and 18.8% in the hospital sector in 2017. Cephalosporin consumption dominated in the hospital sector, at 31.3% of hospital consumption and 16.1% of community consumption.

There are insufficient data to conclude trends in consumption of different pharmacological subgroups in each of the two sectors.

10�7�3 Relative consumption of Core Access, Watch and Reserve groups of antibiotics in community and hospital sectors

The relative consumption of Core Access and Watch group antibiotics is shown in Fig. 10.17 (community) and Fig. 10.18 (hospital) for Core Access antibiotics, Fig. 10.19 (community) and Fig. 10.20 (hospital) for Watch group antibiotics, and is summarized in Table 10.13.

Proportion (%)

Fig. 10.17 Relative consumption of Core Access group antibacterials – community sector^a

Fig. 10.18 Relative consumption of Core Access group antibacterials – hospital sector^a

Fig. 10.19 Relative consumption of Watch group antibacterials – community sector^a

Fig. 10.20 Relative consumption of Watch group antibacterials – hospital sector^a

a Total consumption of antibiotics for this calculation includes J01, vancomycin (A07AA09), colistin (A07AA10), polymyxin B (A07AA05) and metronidazole (P01AB01).

Table 10.13 Relative consumption of Core Access, Watch and Reserve group antibacterials

10�8 Discussion

The analyses for the years 2015–2017 in this report are based on information provided by a commercial data source. VIORTIS data covers around 80–85% of hospital and community sales and can be disaggregated to consumption in the community and hospital sectors. As coverage is not complete, consumption estimates presented in this report will be underestimates of total consumption in Kazakhstan.

Notwithstanding the limitations of the data source, the estimates suggest some reductions in levels of consumption over this period, at 18.2 DID in 2015 and 15.7 DID in 2017. Around 27% of consumption in 2017 was parenteral formulations.

Relative consumption of beta-lactams, cephalosporins, macrolides and quinolones increased slightly over time, offset by decreases in estimates of the relative consumption of “Other J01 antibacterials”.

Of the top 10 oral agents in the J01 class, four are included in the WHO Watch group of antibacterials – ciprofloxacin and levofloxacin (quinolones), and azithromycin and clarithromycin (macrolides).

Ciprofloxacin (12.5%), levofloxacin (7%), azithromycin (6.6%) and clarithromycin (3.8%) combined constituted 29.9% of total consumption of J01 oral antibacterials in 2017.

The Watch group third-generation cephalosporin ceftriaxone constituted 29.1% of the consumption of J01 injection formulations in 2017.

Watch group agents (oral and parenteral combined) comprised 35.1% of total consumption in 2017.

These relatively higher levels of consumption of specific Watch group antibiotics suggest some targets for further investigation, interventions and stewardship activities. For example, the WHO EML (WHO, 2017) suggests limited indications for use of azithromycin, ciprofloxacin, clarithromycin, levofloxacin and ceftriaxone.

Azithromycin is listed on the EML/EMLc as a first-choice option for trachoma, yaws, Chlamydia trachomatis, cholera and Neisseria gonorrhoeae, and as a second-choice option for

Ciprofloxacin is listed in the WHO EML as a first-choice agent for acute invasive bacterial diarrhoea/dysentery, low-risk febrile neutropenia and mild-to-moderate pyelonephritis or prostatitis. It is a second-choice agent for the treatment of cholera and mild-to-moderate complicated intra-abdominal infections.

Clarithromycin is listed on the EML as a first-choice option for severe community-acquired pneumonia and as a second-choice option for pharyngitis.

Levofloxacin is listed on the WHO EML as a reserve second-line drug for the treatment of MDR-TB that should be used in specialized centres adhering to WHO standards for TB control.

Ceftriaxone is listed on the EML/EMLc as a first-choice option for acute bacterial meningitis, severe community-acquired pneumonia, complicated intra-abdominal infections (mild to moderate), hospital-acquired pneumonia, Neisseria gonorrhoeae, and severe pyelonephritis or prostatitis. Ceftriaxone is listed as a second-choice agent for acute invasive bacterial diarrhoea/

dysentery, bone and joint infections, mild-to-moderate pyelonephritis or prostatitis, and sepsis in neonates and children.

Given the limited indications for use of these agents, it could be useful to review existing guidelines and treatment protocols to check alignment with WHO EML recommendations.

Application of the 2019 DDD values has a significant impact on the estimates of total consumption of J01 antibacterials, reducing from 15.7 DID in 2017 using DDD values relevant to year of data to 14.3 DID applying the 2019 DDD values – a reduction of 8.9%. The new DDD values have greatest impact on estimates of consumption of beta-lactam antibacterials (J01C), reducing from 4.4 DID in 2017 using the DDD values relevant to the year of data to 3.1 DID applying the 2019 DDD values – a reduction of 29.5% in absolute values.

Disaggregated data for 2015–2017 are presented in this report. The data illustrate that most consumption occurred in the community (79% of total J01 consumption) and show substantial differences in patterns of consumption of pharmacological subgroups in the two sectors. The relative consumption of beta-lactams (J01C) was higher in the community than hospital sector, while cephalosporin consumption was greater in the hospital than community. The relative consumption of Watch group agents was 47.7% in the hospital sector compared to 31.9% in the community sector. These analyses by sector can provide more detailed information to support stewardship activities.

The data presented here provide a more detailed understanding of the patterns of antimicrobial consumption in Kazakhstan and can help to identify areas for further investigation, allowing the development of targeted interventions to address potential problems identified in the consumption of antibacterials. Interventions targeting medicines should be supported by evidence-based guidelines and treatment protocols.

The WHO Watch and Reserve group classifications offer promise as metrics that indicate actions required and lend themselves to prescribing targets, with lower absolute and relative levels of consumption of these groups of antibiotics desirable.

Not all antibiotics have been classified by WHO into the Access, Watch and Reserve groups. The lists of Watch and Reserve medicines will be modified as evidence emerges and more clinical conditions are reviewed. The estimates presented here are based on total consumption – the relative use of Watch and Reserve group antibiotics would be substantially higher in a hospital-based analysis.

Total DID decreased by 8.9% when the new 2019 DDDs are applied, independent of any intervention by government, agencies or professional groups. Communication strategies will be required so stakeholders are aware of the impact of the DDD changes, along with re-setting of trend lines and targets for changes in antibiotic consumption at national level.

Reference

World Health Organization (2017). WHO Model List of Essential Medicines. 20th list (March 2017).

Geneva: World Health Organization (https://apps.who.int/iris/bitstream/handle/10665/273826/

EML-20-eng.pdf?ua=1, accessed 1 April 2019).

11. KYRGYZSTAN

11�1 Data source and years of data collection

Kyrgyzstan provided data for each of the seven years of data collection (2011–2017). The main sources were import records provided by the drug agency and information provided by wholesalers.

Data derived from importation records will be affected by the cycles of procurement and delivery, potentially giving rise to fluctuations in estimates of consumption that do not relate to actual use of antibacterials by patients and health-care facilities.

11�2 Estimates of volumes of consumption of antibacterials for systemic use (J01)

Total consumption of antibacterials for systemic use (ATC class J01) is examined by route of administration (oral and parenteral formulations) and by pharmacological subgroup (Fig. 11.1 and Table 11.1).

The data show fluctuations in total consumption of J01 antibacterials over time. Within this, there appear to be some anomalies with 2014 data that cannot fully be explained. There may be some influence of medicine import cycles on the patterns observed.

DDD/1000 inhabitants per daya

Quinolone antibacterials (J01M)

Macrolides, lincosamides and streptogramins (J01F) Sulfonamides and trimethoprim (J01E)

Beta-lactams (J01C) Amphenicols (J01B) Other J01 antibacterials (J01G, J01R, J01X)

Tetracyclines (J01A) Other beta-lactams

(includes cephalosporins) (J01D)

KGZ

2011 KGZ

2012 KGZ

2013 KGZ

2014 KGZ

2015 KGZ

2016 KGZ 2017 0

5 10 15 20 25 30 35 40

Fig. 11.1 Total consumption of J01 antibacterials by pharmacological subgroup

a DDD: daily defined dose.

The relative consumption of parenteral antibacterials varied considerably across the years analysed, at 72% in 2011 and 45% in 2017, and as low as 22% in 2014 and 23% in 2016. The reasons for these variations require further investigation (Table 11.1).

The highest levels of consumption were in beta-lactams (J01C), at 8.5 DID in 2011 and 9.9 DID in 2017 (Table 11.1). There is evidence of increasing consumption of cephalosporins (J01D), with 1.8 DID in 2011 and 5 DID in 2017. The large variations in quinolone antibacterial (J01M) consumption over time require further investigation.

These observations relate to total consumption. Different patterns of consumption would be expected in the hospital and community sectors.

Table 11.1 Total consumption of J01 antibacterials by pharmacological subgroup

Class of antibacterial agents DDD/1 000 inhabitants per day^a (% of total^b)

2011 2012 2013 2014 2015 2016 2017

Route of administration

Total 24.0 21.3 21.7 36.8 20.5 24.5 20.8

Class of antibacterial agents

Tetracyclines (J01A) 0.6 Other beta-lactams (includes cephalosporins)

(J01D) 1.8 Sulfonamides and Trimethoprim (J01E) 1

(4.2) 0.8

Macrolides, Lincosamides and Streptogramins

(J01F) 0.8

Quinolone antibacterials (J01M) 0.5

(2.1) Other J01 antibacterials (J01G, J01R, J01X) 10.4

(43.3)

Total 24.0 21.3 21.7 36.8 20.5 24.5 20.8

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

There is evidence of increasing relative consumption of: tetracyclines (J01A), at 2.5% in 2011 and 9.6% in 2017; beta-lactams (J01C), at 35.4% in 2011 and 47.6% in 2017; and cephalosporins (J01D), at 7.5% in 2011 and 24% in 2017. Consumption of quinolones (J01M) decreased, at 2.1% in 2011 and 0.5% in 2017 (Table 11.1). Relative consumption of quinolones was as high as 13.6% in 2014.

Overall consumption of cephalosporins and quinolones combined varied substantially across the years analysed (9% in 2011, 25% in 2017), with large fluctuations in extent of relative use of both cephalosporins and quinolones.

11�3 Relative consumption by choice of agent

11�3�1 Relative consumption of cephalosporins by generation

Third- and fourth-generation cephalosporins have a broader spectrum of activity than first- and second-generation agents, with enhanced coverage of both Gram-positive and Gram-negative organisms. Third-generation cephalosporins are included in the WHO Watch group of antibiotics and fourth-generation agents in the Reserve group.

The relative consumption of first-, second-, third- and fourth-generation cephalosporins in 2011–2017 is shown in Fig. 11.2 and summarized in Table 11.2.

0 20 40 60 80 100

Proportion of total consumption of cephalosporin (%)

Fourth-generation (J01DE) Third-generation (J01DD) Second-generation (J01DC) First-generation (J01DB)

KGZ

2011 KGZ

2012 KGZ

2013 KGZ

2014 KGZ

2015 KGZ

2016 KGZ 2017

Fig. 11.2 Relative consumption of cephalosporins by generation

Table 11.2 Relative consumption of cephalosporins by generation

Class of antibacterial agents DDD/1 000 inhabitants per day^a (% of total^b)

2011 2012 2013 2014 2015 2016 2017

First-generation (J01DB) 0.7 (39) 0.9 (19) 1.8 (45) 0.8 (17) 1 (44) 0.6 (20) 0.6 (13) Second-generation (J01DC) < 0.1 < 0.1 < 0.1 0.1 (2) 0.1 (7) 0.2 (8) < 0.1 Third-generation (J01DD) 1 (59) 3.5 (79) 2.1 (53) 3.8 (80) 1.1 (49) 2 (72) 4.3 (86) Fourth-generation (J01DE) < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 – < 0.1

Total 1.8 4.4 4.0 4.7 2.2 2.9 5.0

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

Decreases in consumption of first-generation agents were seen, at 39% of total cephalosporin consumption in 2011 and 13% in 2017. Cefazolin was the most consumed first-generation agent across the years analysed. Consumption of second-generation agents was low. Consumption of Watch group third-generation agents dominated, generally increasing over time (59% of total cephalosporin consumption in 2011 and 86% in 2017). Ceftriaxone and cefixime comprised 95% and 5% of third-generation agent consumption in 2017. Only small volumes of consumption of fourth-third-generation cephalosporins (Reserve agents) were reported.

11�3�2 Relative consumption of agents within fluoroquinolones (J01MA)

Quinolone antibacterials (J01M) consumption varied widely, representing 0.5 DID (2.1%) of total J01 consumption in 2011, 2.3 DID in 2016 (9.4%) and 0.1 DID (0.5%) of total J01 consumption in 2017, with fluoroquinolones comprising essentially all quinolone consumption (Tables 11.1, 11.3).

Consumption of three fluoroquinolones – ciprofloxacin, norfloxacin and levofloxacin – dominated across most of the years analysed (Table 11.3). Fluoroquinolone data for 2017 require further investigation at national level.

Table 11.3 Relative consumption of agents within fluoroquinolones (J01MA)

Agents DDD/1 000 inhabitants per day^a (% of total^b)

2011 2012 2013 2014 2015 2016 2017

Ofloxacin < 0.1 < 0.1 < 0.1 < 0.1 – < 0.1 < 0.1

Ciprofloxacin 0.3 (65) 0.1 (30) 0.1 (28) 2.3 (46) 0.8 (49) 2 (85) –

Norfloxacin 0.1 (21) 0.2 (38) 0.1 (35) 0.2 (3) 0.1 (7) 0.1 (5) –

Levofloxacin < 0.1 0.1 (24) 0.1 (26) 2.4 (48) 0.7 (42) 0.2 (7) < 0.1

Total 0.5 0.4 0.4 5.0 1.7 2.3 0.1

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

Note: this table includes only those medicines for which the absolute consumption was 0.1 DID or more in any year, or the medicine constituted more than 10% of the total consumption of fluoroquinolones

11�4 The 10 most consumed agents

While the number of J01 antibacterial agents available is large, there is considerable evidence from ESAC-Net and other analyses that consumption tends to be concentrated in a relatively small number.

11�4�1 The 10 most consumed agents – oral formulation

Table 11.4 summarizes consumption of the oral agents that comprise the 10 most consumed in 2017.

Table 11.4 The 10 most consumed agents – oral formulation (2017)

Agent DDD/1 000 inhabitants per day^a

Top 10 Top 9 Top 8 Top 7 Top 6 Top 5 Top 4 Top 3 Top 2 Top 1

Amoxicillin 7.61 7.61 7.61 7.61 7.61 7.61 7.61 7.61 7.61 7.61

Doxycycline 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18

Tetracycline 0.80 0.80 0.80 0.80 0.80 0.80 0.80 0.80

Azithromycin 0.50 0.50 0.50 0.50 0.50 0.50 0.50

Chloramphenicol 0.37 0.37 0.37 0.37 0.37 0.37

Amoxicillin and enzyme

inhibitor 0.31 0.31 0.31 0.31 0.31

Cefixime 0.20 0.20 0.20 0.20

Clarithromycin 0.11 0.11 0.11

Erythromycin 0.09 0.09

Roxithromycin 0.08

Total consumption for

this group of agents 11.25 11.17 11.08 10.97 10.77 10.45 10.09 9.59 8.79 7.61 Total consumption for

all oral J01 agents 11.52 11.52 11.52 11.52 11.52 11.52 11.52 11.52 11.52 11.52 Proportion (%) of total

consumption for oral

J01 antibacterials 97.7% 97.0% 96.2% 95.2% 93.5% 90.8% 87.6% 83.3% 76.3% 66.1%

The 10 listed oral agents represent almost 98% of total oral antibiotic consumption in 2017. Of the top 10 oral agents, five are included in the WHO Watch group of antibacterials – azithromycin, clarithromycin, erythromycin and roxithromycin (macrolides), and cefixime (third-generation cephalosporins).

Azithromycin (4.3%), cefixime (1.7%), clarithromycin (1%), erythromycin (0.8%) and roxithromycin (0.7%) together comprised around 8.5% of J01 oral agent consumption in 2017.

11�4�2 The 10 most consumed agents – parenteral formulation

Table 11.5 summarizes consumption of the parenteral agents that comprise the 10 most consumed in 2017.

Table 11.5 The 10 most consumed agents – parenteral formulation (2017)

Agent DDD/1 000 inhabitants per day^a

Top 10 Top 9 Top 8 Top 7 Top 6 Top 5 Top 4 Top 3 Top 2 Top 1

Ceftriaxone 4.05 4.05 4.05 4.05 4.05 4.05 4.05 4.05 4.05 4.05

Kanamycin 2.16 2.16 2.16 2.16 2.16 2.16 2.16 2.16 2.16

Ampicillin 1.08 1.08 1.08 1.08 1.08 1.08 1.08 1.08

Combinations 0.80 0.80 0.80 0.80 0.80 0.80 0.80

Cefazolin 0.64 0.64 0.64 0.64 0.64 0.64

Streptomycin 0.25 0.25 0.25 0.25 0.25

Azithromycin 0.09 0.09 0.09 0.09

Gentamicin 0.08 0.08 0.08

Benzylpenicillin 0.03 0.03

Cefotaxime 0.03

Total consumption for this

group of agents 9.20 9.17 9.14 9.06 8.97 8.72 8.08 7.28 6.21 4.05

Total consumption for all

parenteral J01 agents 9.29 9.29 9.29 9.29 9.29 9.29 9.29 9.29 9.29 9.29

Proportion (%) of total consumption for parenteral

J01 antibacterials 99.1% 98.8% 98.5% 97.6% 96.6% 93.9% 87.0% 78.5% 66.9% 43.6%

a DDD: daily defined dose.

As shown in Table 11.1, parenteral agents comprised around 45% of total J01 consumption in 2017.

Within this, the Watch group third-generation cephalosporin ceftriaxone alone constituted 43.6% of the consumption of J01 injection formulations.

11�5 Relative consumption of Core Access, Watch and Reserve groups of antibiotics

Analyses based on the WHO Access, Watch and Reserve groups of antibiotics can support antimicrobial stewardship efforts and focus attention on prescribing practices that should be reviewed further.

The relative consumption of Core Access and Watch group antibiotics is shown in Fig. 11.3 and Fig. 11.4, and is summarized in Table 11.6.

Proportion (%)

Other

Core Access group

KGZ

2011 KGZ

2012 KGZ

2013 KGZ

2014 KGZ

2015 KGZ

2016 KGZ 2017 0

20 40 60 80 100

29 37 52 60 73

57 54

Fig. 11.3 Relative consumption of Core Access group of antibiotics classes as a proportion of total consumption^a

a Total consumption of antibiotics for this calculation includes J01, vancomycin (A07AA09), colistin (A07AA10), polymyxin B (A07AA05) and metronidazole (P01AB01).

0 20 40 60 80 100

Proportion (%)

Other Watch group

KGZ 2012 KGZ

2011 KGZ

2013 KGZ

2014 KGZ

2015 KGZ

2016 KGZ 2017

9 23 18 34

17 25 26

Fig. 11.4 Relative consumption of Watch group of antibiotics classes as a proportion of total consumption^a

a Total consumption of antibiotics for this calculation includes J01, vancomycin (A07AA09), colistin (A07AA10), polymyxin B (A07AA05) and metronidazole (P01AB01).

Table 11.6. Relative consumption of antibiotics according to Core Access, Watch and Reserve classification

Category Percentage of total consumption^a

2011 2012 2013 2014 2015 2016 2017

Core Access group 28.9 37.3 52.1 60.0 72.7 57.2 54.4

Watch group 9.4 23.3 18.2 34.0 17.3 25.0 25.8

Reserve group 0.01 0.02 0.02 0.03 0.01 0.01 0.07

Ungrouped 61.7 39.4 29.7 6.0 10.0 17.8 19.7

a Total consumption of antibiotics for this calculation includes J01, vancomycin (A07AA09), colistin (A07AA10), polymyxin B (A07AA05) and metronidazole (P01AB01).

Consumption of Core Access agents has dominated since 2014, representing 54.4% of total consumption in 2017. Watch agents constituted 25–26% of total antibiotic consumption in 2016 and 2017. Consumption of Reserve group agents was low.

11�6 Analyses based on DDDs applied in 2019

To provide new baseline trend data for AMC estimates, analyses for 2015, 2016 and 2017 have been re-run applying the new DDD values that came into effect in January 2019. Data are presented with both existing and new DDDs to illustrate the impact of the changes.

11�6�1 Total consumption of antibacterials for systemic use (J01) by route of administration

The consumption of oral and parenteral (injectable) formulations of J01 antibacterials is shown in Fig. 11.5 (DDD values relevant to year) and Fig. 11.6 (2019 DDD values), and is summarized in Table 11.7.

DDD/1000 inhabitants per day

KGZ

DDD/1000 inhabitants per day

KGZ

Fig. 11.5 Total consumption of J01 antibacterials by route of administration (applying DDD values relevant to year)

Fig. 11.6 Total consumption of J01 antibacterials by route of administration (applying 2019 DDD values)

Table 11.7 Total consumption of J01 antibacterials by route of administration

Route of administration

DDD/1 000 inhabitants per day^a (% of total^b)

DDD values relevant to year of data DDD values applied from January 2019

2015 2016 2017 2015 2016 2017

Oral J01 11.8 (58) 18.9 (77) 11.5 (55) 9.9 (59) 15.7 (74) 8.9 (51)

Parenteral J01 8.6 (42) 5.6 (23) 9.3 (45) 6.8 (41) 5.6 (26) 8.6 (49)

Total 20.5 24.5 20.8 16.7 21.3 17.5

a DDD: daily defined dose.

b Total amounts and percentages may vary slightly owing to rounding.

Application of the 2019 DDD values has a significant impact on the estimates of total consumption of J01 antibacterials, reducing from 20.8 DID in 2017 using DDD values relevant to year of data to 17.5 DID – a reduction of 15.9%.

The relative consumption of oral and parenteral formulations does not change substantially with the application of the 2019 DDDs (oral 55% applying older values and 51% with the 2019 DDD values).

11�6�2 Consumption of antibacterials for systemic use (J01) by pharmacological subgroup

The total consumption of the pharmacological subgroups of J01 antibacterials is shown in Fig. 11.7 (DDD values relevant to year) and Fig. 11.8 (2019 DDD values), and is summarized in Table 11.8.

As noted in section 11.6.1, total DID decreased by 15.9% in 2017.

DDD/1000 inhabitants per day Quinolone

antibacterials

DDD/1000 inhabitants per day Quinolone

antibacterials

Fig. 11.7 Total consumption of J01

antibacterials by pharmacological subgroup (applying DDD values relevant to year)

Fig. 11.8 Total consumption of J01

antibacterials by pharmacological subgroup (applying 2019 DDD values)

Table 11.8 Consumption of J01 antibacterials by pharmacological subgroup

Pharmacological subgroup

DDD/1 000 inhabitants per day^a (% of total^b)

DDD values relevant to year of data DDD values applied from January 2019

2015 2016 2017 2015 2016 2017

Tetracyclines (J01A) 1.1 Other beta-lactams (includes

cephalosporins) (J01D) 2.2 Sulfonamides and trimethoprim

(J01E)

Macrolides, lincosamides and

streptogramins (J01F) 0.9 Quinolone antibacterials (J01M) 1.8

(8.8) 2.3 Other J01 antibacterials (J01G,

J01R, J01X)

Application of the 2019 DDD values has the greatest impact on the estimates of consumption of beta-lactam antibacterials (J01C), reducing from 9.9 DID in 2017 using the DDD values relevant to the year of data to 6.5 DID applying the 2019 DDD values – a reduction of 34.4% in absolute values. Relative consumption of beta-lactams falls from 47.6% to 37.1% of total J01 consumption when the 2019 DDD values are applied.

As the total DIDs decrease with the application of 2019 DDD values, the denominator for calculations is smaller, meaning that the relative consumption of pharmacological subgroups other than beta-lactams generally increases; tetracyclines, for example, increased from 9.6% to 11.4%, cephalosporins from 24% to 28.6% and the macrolides group from 4.8% to 5.7% in 2017.

11�6�3 Relative consumption of Core Access, Watch and Reserve groups of antibiotics

The relative consumption of Core Access and Watch group antibiotics is shown in Fig. 11.9 (DDD values relevant to year) and Fig. 11.10 (2019 DDD values) for Core Access antibiotics, Fig. 11.11 (DDD values relevant to year) and Fig. 11.12 (2019 DDD values) for Watch group antibiotics, and is summarized in Table 11.9.

Proportion (%)

Fig. 11.9 Relative consumption of Core Access group antibacterials (applying DDD values relevant to year)^a

Fig. 11.10 Relative consumption of Core Access group antibacterials (applying 2019 DDD values)^a

Fig. 11.11 Relative consumption of Watch group antibacterials (applying DDD values relevant to year)^a

Fig. 11.12 Relative consumption of Watch group antibacterials (applying 2019 DDD values)^a

Table 11.9 Relative consumption of Core Access, Watch and Reserve group antibacterials

11�7 Discussion

The analyses in this report are based on import records and information provided by wholesalers.

Dans le document Surveillance-Netzwerk des WHO-Regionalbüros für Europa für den Verbrauch antimikrobieller Mittel: AMC-Daten für den Zeitraum 2011–2017 (Page 116-149)