Antibiotic use across the world has jumped by one sixth since 2016, a new study has found, despite continuing concerns that their overuse is leading to the spread of resistant bacteria.
The new research highlights Kuwait as the country with the biggest drop in antibiotic use between 2016 and 2023, while some other nations from the region, including the UAE, have registered increases. Many of the biggest rises in antibiotic use have been in lower and upper middle-income countries and regions, among them Thailand, Central America, West Africa and China.
Published last month [November] in the journal PNAS Environmental Sciences, the study looked at dozens of countries and regions across the world and found that between 2016 and 2023, estimated antibiotic consumption increased 16.3 per cent from 29.5 billion to 34.3 billion defined daily doses. Dr Eili Klein, a senior fellow at the One Health Trust and the first author of the study, told The National that several factors were driving the increase in antibiotic use in middle-income countries.
“The primary reason is economic in nature; in expanding economies individuals can afford a wider range of goods, including better access to health care,” he said. “However, rapid economic growth often outpaces infrastructure development, resulting in inadequate hygiene and sanitation, which can lead to increased rates of infection, which can in turn lead to increased antibiotic use.”
Global issue
Every year well over one million people die because of antimicrobial resistance (AMR), according to the World Health Organisation, with increasing resistance among bacteria to antibiotics the key concern. This occurs when bacteria or other pathogens evolve and no longer respond to antibiotics.
There may be more than 39 million deaths by 2050 because of increased resistance to antibiotics in bacteria, according to a study published this year in The Lancet. Resistance to antibiotics makes common medical procedures such as surgery and the administering of cancer chemotherapy riskier, because any infections that result become harder to treat.
Dr Bharat Pankhania, a senior clinical lecturer in the University of Exeter Medical School in the UK, said there was a problem with antibiotic use “locally, nationally and internationally”.
“They shouldn’t be available over-the-counter and they should be prescribed by people who know about them: the right antibiotic for the right infection,” he said.
Regional impact
While the study indicated a modest increase in antibiotic consumption in the UAE between 2016 and 2023 of up to or less than 10 per cent, a standout finding was that in the same period, antibiotic consumption in Kuwait, which like the UAE was classed as a high-income country in the study, appeared to have dropped significantly, by about 40 per cent.
Dr Averyan Vasylyev, Gulf medical director for GSK, one of the few large pharmaceutical companies still working on developing new antibiotics, said his firm’s data did not indicate that Kuwait had recorded a significant drop in antibiotic use.
“We do not observe the same pattern from the market itself and from the market intelligence that we have access to, neither do we see any change in the pattern from the sales of the antibiotics,” he told The National. “I would not think that that [result in the study] would be the actual case in the clinical practice.”
He said the study did not focus on hospital use of antibiotics in the country, which is where “80 to 90 per cent of the consumption is”.
Saudi Arabia was also recorded in the study as having experienced a drop in antibiotic use, in the low single-digits in percentage terms. Dr Vasylyev said in the UAE there was detailed data available on prescription patterns, even down to the level of the individual hospital, and that doctors were well trained.
“I would say that the situation here, if you compare it to some other countries across emerging markets, is … well developed,” he added.
Public prevention
There are things the public can do to prevent the spread of antimicrobial resistance, Dr Vasylyev said, including ensuring they do not stop taking antibiotics earlier than the prescription from the physician suggests.
Stopping antibiotics early has been blamed for infections coming back and for the spread of resistant forms of bacteria. It is also important, Dr Vasylyev indicated, for people not to use leftover antibiotics at a future time when they believe they need them.
“So many people just store the leftovers and then whenever they have similar symptoms they open the freezer and take the antibiotic while they have, for example, a viral infection. That's very common,” he said.
Among high-income nations, those successful at limiting their use of antibiotics had “followed a holistic approach” that includes building and supporting antimicrobial stewardship programmes, improving infection prevention, restricting access to antibiotics and running public awareness campaigns, Dr Klein said.
In middle-income countries, a range of measures can reduce antibiotic use, he said, including improving access to routine preventive health care, such as vaccines to prevent disease.
“Additional investments are needed in antimicrobial stewardship, including messaging to patients, physicians and pharmacists, to avoid inappropriate use,” he said.
This is not just about avoiding antibiotics when not needed, but also ensuring their use is more tailored to the infection, such as by prescribing narrower-spectrum antibiotics and reducing prescription duration. Countries should also, he suggested, invest in surveillance so that prescribing patterns are well understood and programmes to optimise them can be developed. There is, Dr Klein said, “no silver bullet strategy”.
“The most interesting results, though, suggest that cultural differences in care-seeking and patient demand for antibiotics may be one of the most important factors, and altering cultural perceptions is difficult,” he said.
