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

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.