The 10 most consumed agents – oral formulations

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.

Table 13.5 summarizes consumption of the oral agents that comprise the 10 most consumed in 2017.

Table 13.5 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 and enzyme

inhibitor 7.36 7.36 7.36 7.36 7.36 7.36 7.36 7.36 7.36 7.36

Amoxicillin 2.43 2.43 2.43 2.43 2.43 2.43 2.43 2.43 2.43

Clarithromycin 1.84 1.84 1.84 1.84 1.84 1.84 1.84 1.84

Ciprofloxacin 1.59 1.59 1.59 1.59 1.59 1.59 1.59

Cefuroxime 1.40 1.40 1.40 1.40 1.40 1.40

Cefixime 1.27 1.27 1.27 1.27 1.27

Azithromycin 1.12 1.12 1.12 1.12

Cefalexin 0.76 0.76 0.76

Benzathine

phenoxymethylpenicillin 0.66 0.66

Pipemidic acid 0.38

Community consumption

for this group of agents 18.80 18.42 17.76 17.00 15.88 14.61 13.22 11.63 9.79 7.36 Community consumption

for all oral J01 agents 20.03 20.03 20.03 20.03 20.03 20.03 20.03 20.03 20.03 20.03 Proportion (%) of

Community consumption

for oral J01 antibacterials 93.8% 92.0% 88.7% 84.9% 79.3% 72.9% 66.0% 58.0% 48.9% 36.7%

a DDD: daily defined dose.

The 10 listed oral agents represent almost 94% of total oral antibiotic consumption in 2017. Of the top 10 oral agents, four are included in the WHO Watch group of antibacterials – clarithromycin

and azithromycin (macrolides), ciprofloxacin and pipemidic acid (quinolones), and cefixime (third-generation cephalosporins).

Together, the four Watch agents clarithromycin (9.1%), ciprofloxacin (8%), pipemidic acid (1.8%), cefixime (6.4%) and azithromycin (5.6%) comprised 30.9% of J01 oral agent consumption.

13�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. 13.3 and Fig. 13.4, and is summarized in Table 13.6.

Proportion (%)

Other

Core Access group

MKD

2012 MKD

2013 MKD

2014 MKD

2015 MKD

2016 MKD

2017 0

20 40 60 80 100

53 54 59 56 56 55

Fig. 13.3 Relative consumption of Core Access group of antibiotics classes as a proportion of total consumption^a

a Community 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

MKD

2012 MKD

2013 MKD

2014 MKD

2015 MKD

2016 MKD

2017

28 29 29 31 31 33

Fig. 13.4 Relative consumption of Watch group of antibiotics classes as a proportion of Community consumption^a

Table 13.6 Relative consumption of antibiotics according to Core Access, Watch and Reserve classification

Category Percentage of community consumption^a

2012 2013 2014 2015 2016 2017

Core Access group 52.7 53.9 59.5 55.6 56.4 55.1

Watch group 28.4 28.9 28.7 30.5 31.0 32.5

Reserve group 0.00 0.00 0.00 0.00 0.00 0.00

Ungrouped 18.9 17.3 11.8 13.8 12.6 12.4

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

The relative consumption of Watch agents remained reasonably consistent, at 28–32% of total antibiotic consumption across the years analysed. No community consumption of Reserve group agents was reported.

The 2017 Watch group estimate differs slightly from that shown in the top 10 oral agent analysis in section 13.4 (30.9% versus 32.5%). This occurs because section 13.4 refers only to the top 10 most consumed agents of J01 class antibacterials, not all consumption. The all-agents consumption estimate will also include oral metronidazole (P01AB01), which is not included in analyses of J01 agents.

13�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.

13�6�1 Consumption of antibacterials for systemic use (J01) by pharmacological subgroup

The community consumption of the pharmacological subgroups of J01 antibacterials is shown in Fig. 13.5 (DDD values relevant to year) and Fig. 13.6 (2019 DDD values), and is summarized in Table 13.7.

Application of the 2019 DDD values has the greatest impact on the estimates of consumption of beta-lactam antibacterials (J01C), reducing from 10.4 DID in 2017 using the DDD values relevant to the year of data to 7.2 DID applying the 2019 DDD values – a reduction of 30.8% in absolute values.

Relative consumption of beta-lactams falls from 52% to 42.6% 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: cephalosporins, for example, increased from 18.5% to 21.9%, the macrolides group from 16% to 20.1% and quinolones from 11.5% to 13.6% in 2017.

DDD/1000 inhabitants per day Quinolone

antibacterials

Fig. 13.5 Total consumption of J01

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

Fig. 13.6 Total consumption of J01

antibacterials by pharmacological subgroup (applying 2019 DDD values)

Table 13.7 Relative 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) – – – – – – Other beta-lactams (includes

cephalosporins) (J01D) 3.8 Sulfonamides and trimethoprim

(J01E) 0.4 Macrolides, lincosamides and

streptogramins (J01F) 2.7 Quinolone antibacterials (J01M) 2.5

(12.8) 2.3 Other J01 antibacterials (J01G,

J01R, J01X) – – – – – –

Total 19.6 20.1 20 16.7 17 16.9

a DDD: daily defined dose.

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

13�6�2 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. 13.7 (DDD values relevant to year) and Fig. 13.8 (2019 DDD values) for Core Access antibiotics, Fig. 13.9 (DDD values relevant to year) and Fig. 13.10 (2019 DDD values) for Watch group antibiotics, and is summarized in Table 13.8.

Proportion (%)

Fig. 13.7 Relative consumption of Core Access group antibacterials (applying DDD values relevant to year)^a

Fig. 13.8 Relative consumption of Core Access group antibacterials (applying 2019 DDD values)^a

Fig. 13.9 Relative consumption of Watch group antibacterials (applying DDD values relevant to year)^a

Fig. 13.10 Relative consumption of Watch group antibacterials (applying 2019 DDD values)^a

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

Table 13.8 Relative consumption of Core Access and Watch group antibacterials

13�7 Discussion

The analyses in this report are based on reimbursement records provided by the Health Insurance Fund.

Community consumption of J01 antibacterials was reasonably stable over the period 2014–2017, at around 19–20 DID. Only oral agents were prescribed in the community.

Relative consumption of beta-lactams increased over time, offset by decreases in relative consumption of cephalosporin and quinolone antibacterials.

Of the top 10 oral agents, four are included in the WHO Watch group of antibacterials – clarithromycin and azithromycin (macrolides), ciprofloxacin (quinolones) and cefixime (third-generation cephalosporins).

Clarithromycin (9.1%), ciprofloxacin (8%), pipemidic acid (1.8%), cefixime (6.4%) and azithromycin (5.6%) together comprised 30.9% of J01 oral agent consumption.

Watch group agents comprised almost one third (32.5%) 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, clarithromycin, cefixime and ciprofloxacin.

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 acute invasive bacterial diarrhoea/dysentery and Neisseria gonorrhoeae.

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

Cefixime is not listed as a first-choice treatment option for any specific indications on the EML/EMLc, but is a second-choice treatment for acute invasive bacterial diarrhoea/dysentery and for the treatment of Neisseria gonorrhoeae. In injection formulation, it is third-generation cephalosporin of choice for use in hospitalized neonates.

Ciprofloxacin is listed on 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.

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 20.0 DID in 2017 using DDD values relevant to year of data to 16.9 DID applying the 2019 DDD values – a reduction of 15.5%. The new DDD values have greatest impact on estimates of consumption of beta-lactam antibacterials (J01C), reducing from 10.4 DID

in 2017 using the DDD values relevant to the year of data to 7.2 DID applying the 2019 DDD values – a reduction of 30.8% in absolute values.

The data presented here provide a more detailed understanding of the patterns of antimicrobial consumption in North Macedonia 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.

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. Interventions targeting medicines should be supported by evidence-based guidelines and treatment protocols.

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 15.5% when the new 2019 DDDs were 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).

14. REPUBLIC Of MOLDOVA

14�1 Data source and years of data collection

The Republic of Moldova provided data for each of the seven years of data collection (2011–2017).

The main sources were import records from the drug agency and information provided by local pharmaceutical manufacturers. 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. Local manufacturer records need to be disaggregated to products for local consumption and products exported to other countries.

14�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. 14.1 and Table 14.1).

The data show fluctuations in total consumption of J01 antibacterials over time. While the data suggest a trend to reductions in total consumption between 2013 and 2015, the 2016–2017 estimates are higher. The reasons for this fluctuating pattern are unclear and require further investigation.

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)

MDA

2011 MDA

2012 MDA

2013 MDA

2014 MDA

2015 MDA

2016 MDA 2017 0

5 10 15 20 25

Fig. 14.1 Total consumption of J01 antibacterials by pharmacological subgroup

Except for 2015 estimates, the relative consumption of parenteral antibacterials remained reasonably stable, at around 18–21% of total J01 consumption (Table 14.1).

The highest levels of consumption were in beta-lactams (J01C), at 7.5 DID in 2011 and 6.9 DID in 2017 (Table 14.1). There is some evidence of increasing consumption of cephalosporin antibacterials (J01D), with 3.2 DID in 2011 and 4.3 DID in 2017.

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

Table 14.1 Total consumption of J01 antibacterials by route of administration and 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 21.3 13.6 22.8 17.7 13.8 18.7 19.5

Class of antibacterial agents

Tetracyclines (J01A) 1.2 Other beta-lactams (includes cephalosporins)

(J01D) 3.2 Sulfonamides and Trimethoprim (J01E) 1.7

(8) Macrolides, Lincosamides and Streptogramins

(J01F)

Quinolone antibacterials (J01M) 2.7

(12.7) 1.9 Other J01 antibacterials (J01G, J01R, J01X) 2.5

(11.7) 2.4

Total 21.3 13.6 22.8 17.7 13.8 18.7 19.5

a DDD: daily defined dose.

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

There is evidence of increasing relative consumption of cephalosporins (J01D), at 15% in 2011 and 22.1% in 2017, and decreasing consumption of sulphonamide group antibacterials (J01E), at 8% in 2011 and 4.6% in 2017.

The relative consumption of cephalosporins and quinolones combined increased slightly over time (28% in 2011, 34% in 2017), mostly due to increases in consumption of cephalosporins.

14�3 Relative consumption by choice of agent

14�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. 14.2 and summarized in Table 14.2. Table 14.3 summarizes the most consumed cephalosporins within each generation of agent.

0 20 40 60 80 100

Proportion of total consumption of cephalosporin (%)

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

MDA

2011 MDA

2012 MDA

2013 MDA

2014 MDA

2015 MDA

2016 MDA 2017

Fig. 14.2 Relative consumption of cephalosporins by generation

Table 14.2 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) 1.3 (41) 0.6 (27) 0.5 (16) 1 (28) 0.3 (16) 0.6 (14) 0.4 (9) Second-generation (J01DC) 0.5 (15) 0.6 (26) 0.7 (24) 1 (26) 1 (45) 1.3 (31) 1.9 (44) Third-generation (J01DD) 1.4 (43) 1 (47) 1.9 (61) 1.7 (45) 0.9 (39) 2.3 (55) 2 (47) Fourth-generation (J01DE) < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1

Total 3.2 2.1 3.1 3.7 2.2 4.1 4.3

a DDD: daily defined dose.

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

Substantial decreases in consumption of first-generation agents were seen (41% of total cephalosporin consumption in 2011 and 9% in 2017). Consumption of second-generation agents, mostly cefuroxime, increased over time, representing 44% of cephalosporin consumption in 2017. Ceftriaxone comprised 78% of third-generation agent consumption in 2017. Only small volumes of consumption of fourth-generation cephalosporins (Reserve agents) were reported.

Table 14.3 Most consumed agents within each generation of cephalosporins

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

2011 2012 2013 2014 2015 2016 2017

First-generation (J01DB)

Cefalexin 0.5 (36) 0.2 (28) 0.2 (38) 0.3 (34) 0.2 (72) 0.1 (21) 0.2 (54)

Cefazolin 0.8 (64) 0.4 (72) 0.3 (62) 0.7 (66) < 0.1 0.4 (79) 0.2 (46)

Second-generation (J01DC)

Cefuroxime 0.5 (96) 0.5 (86) 0.7 (99) 0.9 (90) 0.9 (92) 1.2 (95) 1.8 (96)

Third-generation (J01DD)

Cefotaxime 0.2 (12) < 0.1 0.2 (13) 0.2 (11) < 0.1 0.2 (8) < 0.1

Ceftazidime 0.1 (8) < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1

Ceftriaxone 0.9 (66) 0.7 (69) 1.3 (75) 1.1 (66) 0.5 (56) 1.7 (77) 1.5 (78)

Cefixime 0.2 (12) 0.2 (19) 0.1 (6) 0.2 (10) 0.1 (15) 0.1 (6) < 0.1

Cefoperazone < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 0.1 (5)

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 for the nominated generation of cephalosporins.

14�3�2 Relative consumption of agents within fluoroquinolones (J01MA)

Quinolone antibacterials (J01M) represented 2.4 DID (12%) of total J01 consumption in 2017, with fluoroquinolones comprising 2.2 DID – 92% of quinolone consumption. Two fluoroquinolones – ciprofloxacin and levofloxacin – dominated, representing 40% and 41% of fluoroquinolone consumption in 2017 (Table 14.4).

Table 14.4 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 (5) 0.2 (14) 0.3 (12) 0.3 (10) 0.2 (11) 0.2 (7) 0.1 (6)

Ciprofloxacin 1.3 (50) 0.7 (42) 1 (39) 1.1 (39) 0.7 (42) 0.8 (33) 0.9 (40)

Pefloxacin < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1

Norfloxacin 0.4 (15) < 0.1 0.3 (13) 0.3 (9) 0.3 (18) 0.3 (14) 0.2 (8)

Levofloxacin 0.7 (27) 0.6 (37) 0.8 (32) 1 (38) 0.4 (25) 1 (43) 0.9 (41)

Moxifloxacin < 0.1 < 0.1 < 0.1 0.1 (5) < 0.1 < 0.1 0.1 (5)

Gemifloxacin – – – < 0.1 < 0.1 < 0.1 < 0.1

Gatifloxacin < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1 < 0.1

Total 2.5 1.7 2.5 2.8 1.5 2.4 2.2

a DDD: daily defined dose.

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

14�4 The 10 most consumed agents

14�4�1 The 10 most consumed agents – oral formulation

Table 14.5 summarizes consumption of the oral agents that comprise the 10 most consumed in 2017.

Table 14.5 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 and enzyme

inhibitor 2.99 2.99 2.99 2.99 2.99 2.99 2.99 2.99 2.99 2.99

Amoxicillin 2.41 2.41 2.41 2.41 2.41 2.41 2.41 2.41 2.41

Cefuroxime 1.36 1.36 1.36 1.36 1.36 1.36 1.36 1.36

Azithromycin 1.10 1.10 1.10 1.10 1.10 1.10 1.10

Doxycycline 0.91 0.91 0.91 0.91 0.91 0.91

Sulfamethoxazole and

trimethoprim 0.87 0.87 0.87 0.87 0.87

Levofloxacin 0.85 0.85 0.85 0.85

Ciprofloxacin 0.84 0.84 0.84

Clarithromycin 0.75 0.75

Furazidin 0.59

Total consumption for this

group of agents 12.67 12.08 11.33 10.48 9.63 8.76 7.85 6.76 5.39 2.99

Total consumption for all

oral J01 agents 15.50 15.50 15.50 15.50 15.50 15.50 15.50 15.50 15.50 15.50 Proportion (%) of total

consumption for oral J01

antibacterials 81.7% 77.9% 73.1% 67.6% 62.1% 56.5% 50.7% 43.6% 34.8% 19.3%

a DDD: daily defined dose.

The 10 listed oral agents represent just under 82% of total oral antibiotic consumption in 2017. Of the top 10 oral agents, four are included in the WHO Watch group of antibacterials – azithromycin and clarithromycin (macrolides), and levofloxacin and ciprofloxacin (quinolones).

Azithromycin (7.1%), levofloxacin (5.5%), ciprofloxacin (5.5%) and clarithromycin (4.8%) combined constituted around 23% of total consumption of J01 oral antibacterials in 2017.

14�4�2 The 10 most consumed agents – parenteral formulation

Table 14.6 summarizes consumption of the parenteral agents that comprise the 10 most consumed in 2017.

As shown in Table 14.1, parenteral agents comprised around 21% of total J01 consumption in 2017.

Within this, the Watch group third-generation cephalosporins ceftriaxone (38.6%) and cefotaxime (2.4%) constituted 41% of the consumption of J01 injection formulations.

Table 14.6 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 1.54 1.54 1.54 1.54 1.54 1.54 1.54 1.54 1.54 1.54

Amoxicillin 0.68 0.68 0.68 0.68 0.68 0.68 0.68 0.68 0.68

Cefuroxime 0.47 0.47 0.47 0.47 0.47 0.47 0.47 0.47

Ampicillin 0.22 0.22 0.22 0.22 0.22 0.22 0.22

Cefazolin 0.18 0.18 0.18 0.18 0.18 0.18

Amoxicillin and enzyme

inhibitor 0.12 0.12 0.12 0.12 0.12

Metronidazole 0.11 0.11 0.11 0.11

Cefoperazone 0.11 0.11 0.11

Cefotaxime 0.10 0.10

Gentamicin 0.09

Total consumption for this

group of agents 3.62 3.53 3.43 3.33 3.22 3.09 2.91 2.70 2.23 1.54

Total consumption for all

parenteral J01 agents 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00 4.00

Proportion (%) of total consumption for parenteral

J01 antibacterials 90.6% 88.3% 85.9% 83.2% 80.5% 77.4% 72.9% 67.5% 55.7% 38.6%

a DDD: daily defined dose.

14�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. 14.3 and Fig. 14.4, and is summarized in Table 14.7.

Proportion (%)

Other

Core Access group

MDA

2011 MDA

2012 MDA

2013 MDA

2014 MDA

2015 MDA

2016 MDA 2017 0

20 40 60 80 100

64 58 63 56 59 51 52

Fig. 14.3 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

0 20 40 60 80 100

Proportion (%)

Other Watch group

MDA 2012 MDA

2011 MDA

2013 MDA

2014 MDA

2015 MDA

2016 MDA 2017

28 31 28 36 30 34 33

Fig. 14.4 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 14.7 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 63.8 57.9 63.0 55.8 58.7 50.7 51.7

Watch group 27.7 31.3 28.4 36.3 30.0 34.3 32.6

Reserve group 0.08 0.06 0.00 0.02 0.01 0.01 0.09

Ungrouped 8.4 10.8 8.6 7.9 11.3 15.0 15.6

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

The relative consumption of Watch agents was 33–34% of total antibiotic consumption in 2016 and 2017. Consumption of Reserve group agents was low.

14�6 Analyses based on DDDs applied in 2019

14�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. 14.5 (DDD values relevant to year) and Fig. 14.6 (2019 DDD values), and is summarized in Table 14.8.

DDD/1000 inhabitants per day

MDA 2015 MDA

2016 MDA 2017

Parenteral antibacterials Oral antibacterials

0 5 10 15 20 25

DDD/1000 inhabitants per day

MDA 2015 MDA

2016 MDA 2017

Parenteral antibacterials Oral antibacterials

0 5 10 15 25 20

Fig. 14.5 Total consumption of J01 antibacterials by route of administration (applying DDD values relevant to year)

Fig. 14.6 Total consumption of J01 antibacterials by route of administration (applying 2019 DDD values)

Table 14.8 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 12.1 (88) 14.8 (79) 15.5 (79) 11.4 (88) 13.5 (81) 13.7 (80)

Parenteral J01 1.7 (12) 3.9 (21) 4 (21) 1.5 (12) 3.2 (19) 3.4 (20)

Total 13.8 18.7 19.5 12.9 16.7 17.1

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 19.5 DID in 2017 using DDD values relevant to year of data to 17.1 DID applying the 2019 DDD values – a reduction of 12.3%.

The relative consumption of oral and parenteral formulations does not change substantially with the application of the 2019 DDDs (oral 79% applying older values and 80% with the 2019 DDD values).

14�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. 14.7 (DDD values relevant to year) and Fig. 14.8 (2019 DDD values), and is summarized in Table 14.9.

As noted in section 14.6.1, total DID decreased by 12.3% in 2017.

DDD/1000 inhabitants per day Quinolone

antibacterials

Fig. 14.7 Total consumption of J01

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

Fig. 14.8 Total consumption of J01

antibacterials by pharmacological subgroup (applying 2019 DDD values)

Table 14.9 Relative 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) Quinolone antibacterials (J01M) 1.7

(12.3) 2.7 Other J01 antibacterials (J01G,

J01R, J01X) 0.7

Total 13.8 18.7 19.5 12.9 16.7 17.1

a DDD: daily defined dose.

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

Application of the 2019 DDD values has the greatest impact on the estimates of consumption of beta-lactam antibacterials (J01C), reducing from 6.9 DID in 2017 using the DDD values relevant to the year of data to 4.6 DID applying the 2019 DDD values – a reduction of 33.3% in absolute values.

Relative consumption of beta-lactams falls from 35.4% to 26.9% of total J01 consumption when the 2019 DDD values are applied.

Dans le document Surveillance-Netzwerk des WHO-Regionalbüros für Europa für den Verbrauch antimikrobieller Mittel: AMC-Daten für den Zeitraum 2011–2017 (Page 152-0)