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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pharmacol. | doi: 10.3389/fphar.2018.01156

Antimicrobial Medicines Consumption in Eastern Europe and Central Asia – an Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action

 Jane Robertson1, 2*, Kotoji Iwamoto1, Iris Hoxha3,  Lilith Ghazaryan4,  Vafa Abilova5, Ana Cvijanovic6,  Halina Pyshnik7, Marina Darakhvelidze8, Larisa Makalkina9,  Arianit Jakupi10, Aigul Dzhakubekova11, Angela Carp12, Lidija Cizmovic13, Svetlana Ratchina14, Vesela Radonjic15,  Salomuddin Yusufi16, Mesil Aksoy17, Muhabbat Ibragimova18,  Brian Godman19, 20, 21, 22, Hans Kluge1 and Hanne Pedersen1
  • 1World Health Organization (WHO Denmark), Denmark
  • 2Department of Clinical Pharmacology, The University of Newcastle, NSW, Australia
  • 3Department of Pharmacy, University of Medicine, Albania
  • 4Scientific Centre of Drug and Medical Technology Expertise of Ministry of Health, Armenia
  • 5Department of Import Medicines and Medical Devices, Analytical Expertise Center, Ministry of Health, Azerbaijan, Azerbaijan
  • 6Sector for Providing Information on Drugs and Medical Products in Agency for Medicinal products and Medical Devices of Bosnia and Herzegovina, Bosnia and Herzegovina
  • 7Department of Pharmaceutical Inspection and Organization of Medicines Supply, Ministry of Health,, Belarus
  • 8Health Care Department of the Ministry of Labour, Health and Social Affairs, Georgia
  • 9Department of Pharmacology, Astana Medical University, Kazakhstan
  • 10A2 - Pharmaceutical Consulting and UBT - Higher Education Institution, Serbia
  • 11Unit on Specialized Expertise of Medicines of Department of Drug Provision and Medical Devices, Ministry of Health,, Kyrgyzstan
  • 12P.I. Coordination, Implementation and Monitoring Unit of the Health System Projects, Moldova
  • 13Department for Establishing Maximum Prices and Monitoring Consumption of Medicines, Agency for Medicines and Medical Devices, Montenegro
  • 14Russian Friendship University,, Russia
  • 15National Centre for Information on Medicines and Medical Device, Medicines and Medical Devices Agency of Serbia and Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Serbia
  • 16Vice-Rector for Science, Avicenna Tajik State Medical University,, Tajikistan
  • 17Turkish Medicines and Medical Devices Agency, Department of Rational Use of Medicines, Ministry of Health,, Turkey
  • 18Center of Policy on Medicines and Medical Devices, Central Directorate for Quality Control of Medicines and Medical Equipment, Ministry of Health,, Uzbekistan
  • 19University of Strathclyde, United Kingdom
  • 20University of Liverpool, United Kingdom
  • 21Karolinska Institutet (KI), Sweden
  • 22School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa, South Africa

Introduction
Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network.
Objectives
(i) Analyse 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to DDDs in 2019 for some commonly used antibiotics; (v) consider the utility of quantitative metrics of consumption for policy action.
Methods
Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and defined daily doses (DDD) methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes.
Findings
Total J01 consumption in 2015 ranged 8·0-41·5 DID (mean 21·2 DID), generally lower than in 2011 (6·4–42·3 DID, mean 23·6 DID). Beta-lactam penicillins, cephalosporins and quinolones represented 16·2 to 56·6%, 9·4 to 28·8%, and 7·5 to 24·6% of total J01 consumption respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17·3 to 49·5% of total consumption (mean 30·9%). Variability was similar to 2015 ESAC-Net data (11·7 to 38·3 DID; mean 22.6 DID).
DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12·0% (7·3-35·5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest.
Discussion
Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

Keywords: Antibiotic utilization, antimicrobial medicines consumption , national surveillance networks, Cross-national comparative study, Quality indicators, Eastern Europe, Central Asia

Received: 23 Aug 2018; Accepted: 24 Sep 2018.

Edited by:

Dominique J. Dubois, Free University of Brussels, Belgium

Reviewed by:

Robert L. Lins, Independent researcher
Mihajlo (Michael) Jakovljevic, Department of Health Economics, Lund University, Sweden  

Copyright: © 2018 Robertson, Iwamoto, Hoxha, Ghazaryan, Abilova, Cvijanovic, Pyshnik, Darakhvelidze, Makalkina, Jakupi, Dzhakubekova, Carp, Cizmovic, Ratchina, Radonjic, Yusufi, Aksoy, Ibragimova, Godman, Kluge and Pedersen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jane Robertson, World Health Organization (WHO Denmark), Copenhagen, Denmark, robertsonj@who.int