lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Global Antibiotic Consumption in Humans, 2000 to 2018: A Spatial Modelling Study

44 Pages Posted: 11 Dec 2020

See all articles by Annie J. Browne

Annie J. Browne

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Michael G. Chipeta

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Georgina Haines-Woodhouse

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Emmanuelle P. A. Kumaran

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Bahar H. Kashef Hamadani

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford

Sabra Zaraa

School of Pharmacy and School of Public Health, University of Washington

Nathaniel J. Henry

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Aniruddha Deshpande

Institute for Health Metrics and Evaluation, University of Washington

Robert C. Reiner Jnr

Institute for Health Metrics and Evaluation, University of Washington

Nicholas P. J. Day

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford

Alan Lopez

University of Melbourne

Susanna Dunachie

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford

Catrin E. Moore

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford

Andy Stergachis

University of Washington - School of Public Health

Simon I. Hay

University of Washington - Department of Health Metrics Sciences

Christiane Dolecek

University of Oxford - Centre for Tropical Medicine and Global Health

More...

Abstract

Background: Antimicrobial resistance (AMR) is a serious threat to global public health. The World Health Organization emphasizes the need for countries to monitor antibiotic consumption in order to combat AMR. Many low- and middle-income countries (LMICs) lack surveillance capacity; geostatistical models can be used to estimate antibiotic consumption.

Methods: We used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children under five years with lower respiratory tract infections (LRI) in LMICs, from 2000 to 2018. Antibiotic consumption data were obtained from multiple sources, including IQVIA, WHO and ESAC-Net. The estimates of the antibiotic usage model were used alongside socio-demographic and health covariates to inform a model of total antibiotic consumption covering 204 countries from 2000 to 2018.FindingsWe analysed 209 surveys conducted between 2000 and 2018, covering 284,045 children with LRI. We identified large national and subnational variations of antibiotic usage in LMICs, with the lowest levels estimated in sub-Saharan Africa and the highest in Eastern Europe and Central Asia. We estimated a global antibiotic consumption rate of 14·3 [95% uncertainty interval 13·2-15·6] defined daily doses (DDD) per 1000 population per day in 2018 (40·2 [37·2-43·7] billion DDDs), an increase of 46% from 9·8 [9·2-10·5] DDD per 1000 per day in 2000. We identified large spatial disparities, with antibiotic consumption rates varying from 5·0 [4·8-5·3] DDD per 1000 per day in the Philippines to 45·9 DDD per 1000 per day in Greece in 2018. In addition, we present trends in consumption of different classes of antibiotics for selected GBD regions using the IQVIA, WHO and ESAC-net input data.

Interpretation: This is the first study that incorporates antibiotic usage and consumption data and utilises geostatistical modelling techniques to estimate antibiotic consumption for 204 countries from 2000 to 2018. Our analysis identifies both high rates of antibiotic consumption and a lack of access to antibiotics, and provides a benchmark for future interventions.

Funding Statement: This work was funded by a grant from the Fleming Fund, UK Department of Health and Social Care; the Wellcome Trust (209142/Z/17/Z) and the Bill and Melinda Gates Foundation (OPP1176062).

Declaration of Interests: All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. None of the authors reports any relevant financial or other conflicts of interests. AS has been the recipient of research grants from the Bill and Melinda Gates Foundation.

Ethics Approval Statement: This research was exempted from ethics approval as all analyses were performed on publicly accessible de-identified data.

Suggested Citation

Browne, Annie J. and Chipeta, Michael G. and Haines-Woodhouse, Georgina and Kumaran, Emmanuelle P. A. and Hamadani, Bahar H. Kashef and Zaraa, Sabra and Henry, Nathaniel J. and Deshpande, Aniruddha and Jnr, Robert C. Reiner and Day, Nicholas P. J. and Lopez, Alan and Dunachie, Susanna and Moore, Catrin E. and Stergachis, Andy and Hay, Simon I. and Dolecek, Christiane, Global Antibiotic Consumption in Humans, 2000 to 2018: A Spatial Modelling Study. Available at SSRN: https://ssrn.com/abstract=3746925 or http://dx.doi.org/10.2139/ssrn.3746925

Annie J. Browne

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Michael G. Chipeta

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Georgina Haines-Woodhouse

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Emmanuelle P. A. Kumaran

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Bahar H. Kashef Hamadani

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford ( email )

Sabra Zaraa

School of Pharmacy and School of Public Health, University of Washington ( email )

Nathaniel J. Henry

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Aniruddha Deshpande

Institute for Health Metrics and Evaluation, University of Washington

Robert C. Reiner Jnr

Institute for Health Metrics and Evaluation, University of Washington ( email )

Nicholas P. J. Day

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford ( email )

Alan Lopez

University of Melbourne ( email )

185 Pelham Street
Carlton, Victoria 3053
Australia

Susanna Dunachie

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford ( email )

Catrin E. Moore

Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford ( email )

Andy Stergachis

University of Washington - School of Public Health ( email )

Seattle, WA
United States

Simon I. Hay

University of Washington - Department of Health Metrics Sciences ( email )

Seattle, WA
United States

Christiane Dolecek (Contact Author)

University of Oxford - Centre for Tropical Medicine and Global Health ( email )

United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
463
Downloads
88
PlumX Metrics