A startling new study has found that between 2000 and 2015, global consumption of antibiotics jumped 65 percent. An international team of researchers generated the results from data gathered from 76 countries, finding that while antibiotic use soared in low- and middle-income countries (LMICs), consumption in high-income countries (HICs) was static but still considerably higher per capita than LIMCs.
The massive increase in antibiotic use is not just related to overall population growth but also rising economic levels and urbanization in low and middle income countries. Over the 15 years examined in the study, LMICs increased total antibiotic use by 114 percent. Despite antibiotic use in high-income countries remaining relatively static, the overall level of consumption in HICs was still much higher than most poorer countries.
Addressing these findings requires a two-pronged strategy – the need to reduce overall consumption rates in richer countries, while trying to slow or moderate consumption in poorer countries without stifling their access to necessary drugs. As the authors of the study fairly note, "there is a need to balance access to essential medications, particularly in LMICs where the burden of infectious diseases likely still outweighs the burden of resistant infections and where in many countries there is a significant unmet need for antibiotics."
The researchers suggest implementing something like a stewardship program in some LMICs to help integrate growing antibiotic use with other health-care programs designed to improve general hygienic conditions and reduce the incidences of bacterial infections appearing in the first place. Clean water programs, large-scale vaccinations, and better sanitation are all strategies that need to be implemented in order to curb the growing antibiotic use in these regions.
In higher income countries the problem is a little more complex. A 2016 study led by the CDC found that over 30 percent of antibiotics prescribed in the United States are unnecessary. As well as doctors needing to be more judicious with their antibiotic prescriptions, it is suggested that patients also need to take responsibility in understanding when they are not needed.
Perhaps the most alarming part of the study was the note citing the global increase in consumption of antibiotics referred to as "drugs of last resort." Colistin, one of these last-resort antibiotics that has seen a rise in global use, was developed in the mid-20th century but temporarily abandoned due to its kidney toxicity. Despite its toxic side effects, the antibiotic returned to favor in the 1990s as an emergency solution to the increasing prevalence of drug-resistant bacteria.
The current estimation is that in 2015 there were over 42 billion "defined daily doses" (DDDs) of antibiotics consumed, or around 15 DDDs per 1,000 people per day. The study frighteningly extrapolates that, assuming no policy changes or alterations in current rates of growth, by 2030 that total consumption would increase over 200 percent to 128 billion DDDs.
"Finding workable solutions is essential, and we now have key data needed to inform those solutions," says study co-author Eili Klein. "Now, more than ever, we need effective interventions, including stewardship, public education, and curbing overuse of last-resort antibiotics."
The study was published in the journal Proceedings of the National Academy of Sciences.
Source: Burness via Eurekalert