Consumption of antibiotics in the community back to pre-pandemic levels in the European Union and European Economic Area

This year’s European Antibiotic Awareness Day (EAAD) focuses on the targets outlined in the 2023 Council Recommendation to step up efforts in the European Union (EU) against antimicrobial resistance in a One Health approach. [1] Those recommendations formulate the 2023 goal to reduce total antibiotic consumption (community and hospital sectors combined) by 20%, using consumption data from 2019 as baseline.

Consumption of antibiotics in the community accounts for around 90% of the total use. This means, that a substantial and consistent decline in the use of antibiotics in this sector will be key on the way towards reaching the set goals for 2030 which aim at preventing and reducing antimicrobial resistance overall.

During the first year of the COVID-19 pandemic, data from the European Union (EU)/European Economic Area (EEA) showed an unprecedented 18.5% decrease in community consumption of antibiotics in 2020 compared with the 2019 baseline. This drop has been related to the use of non-pharmaceutical interventions (e.g. physical distancing or wearing of face masks) which reduced overall spread of pathogens, and to the fact that prescriptions of antibiotics were affected by the disrupted access to healthcare services during the first year of the pandemic.

Unusual fluctuation between 2019 and 2022
In their rapid communication published in Eurosurveillance on occasion of EAAD and World AMR Awareness Week, Ventura-Gabarró et al. present most recent data reported to the European Surveillance of Antimicrobial Consumption Network. [2] They show that the observed decrease from 2020 did not last.

Instead, along with the gradual lifting of interventions across the EU/EEA, mean community consumption went up again and increased by 18.8% between 2021 and 2022 with no significant difference from the pre-pandemic level in 2019. This rebound in consumption of antibacterials for systemic use in the community sector moved antibiotic consumption rates back towards the 2019 baseline value.

The data presented by Ventura-Gabarró et al. show different patterns of antibiotic consumption across the EU/EEA countries. In 13 of 27 countries, community antibiotic consumption was higher in 2022 than in 2019, with an average increase of 8.4% among these 13 countries (range: 0.6–26.9).

From 2020 to 2021, the EU/EEA overall, as in 15 individual countries (Austria, Denmark, Estonia, Iceland, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovenia, Spain and Sweden), observed no or just a marginal (less than +/−3%) change in antibiotic consumption in the community. Between 2021 and 2022 pre-pandemic levels of 2019 were reached again with an average increase of 20.5%.

The authors highlight that “although the resurgence of both viral and bacterial respiratory tract infections during the latter part of our study period might partly explain this rebound in antibiotic consumption, the increase could also reflect a missed opportunity to strengthen and reinforce prudent antibiotic use.” They conclude that “the COVID-19-pandemic had a substantial impact on community antibiotic consumption in the EU/EEA between 2020 and 2022. Countries exhibited different patterns of antibiotic consumption, underlining the importance of understanding each country in its own context. Further examination into local prescribing and consumption behaviours for specific antibiotic groups can inform effective stewardship interventions and bring the EU/EEA closer to its antibiotic consumption targets for 2030.”

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References/notes to editors:
[1] European Antibiotic Awareness Day (EAAD) is a European health initiative coordinated by ECDC. It provides a platform and support for national campaigns on the prudent use of antibiotics in the EU/EEA and take place each year across Europe on 18 November. EAAD is organised in partnership with the World AMR Awareness Week, organised annually by the World Health Organization from 18 to 24 November. See more: https://www.ecdc.europa.eu/en/news-events/european-antibiotic-awareness-day-eaad-2023

[2] Ventura-Gabarró Cèlia, Leung Vivian H, Vlahović-Palčevski Vera, Machowska Anna, Monnet Dominique L, Högberg Liselotte Diaz, ESAC-Net study group. Rebound in community antibiotic consumption after the observed decrease during the COVID-19 pandemic, EU/EEA, 2022. Euro Surveill. 2023;28(46):pii=2300604. https://doi.org/10.2807/1560-7917.ES.2023.28.46.2300604

The authors analysed community sector consumption of antibacterials for systemic use group (anatomical therapeutic chemical (ATC) group J01), quantified as defined daily doses (DDD) per 1,000 inhabitants per day (ATC/DDD index for 2023), and as reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net)

[3] Antibiotics, also known as antimicrobial drugs, are medicines that can kill or inhibit the growth of bacteria to cure infections in people, animals and sometimes plants. Bacteria have antibiotic resistance when specific antibiotics have lost their ability to kill or stop the growth of the bacteria. Some bacteria are naturally resistant to certain antibiotics (intrinsic or inherent resistance). A more worrying problem is when some bacteria, that are normally susceptible to antibiotics, become resistant as a result of genetic changes (acquired resistance). Resistant bacteria survive in the presence of the antibiotic and continue to multiply causing longer illness or even death. Infections caused by resistant bacteria may require more care as well as alternative and more expensive antibiotics, which may have more severe side effects. Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations. See also: https://www.ecdc.europa.eu/en/antimicrobial-resistance/facts/factsheets/general-public