Countries risking spread of superbugs by failing to monitor antibiotic usage

Anne Gulland
Too few countries monitor data on antibiotic consumption - Bloomberg

Many countries are using too many antibiotics which should only be used as a last resort, risking the spread of superbugs, the World Health Organization has warned.

At the launch of a campaign promoting a tool to encourage countries to collect data on antibiotic consumption the WHO revealed that out of the 65 countries which collect such information, only 29 have met goals to limit the use of precious antibiotics.

Experts say ensuring antibiotics are only used when absolutely necessary is a vital way to stop the spread of antimicrobial resistance (AMR). A United Nations report published in April warned that unless urgent action is taken AMR will cause 10 million deaths a year by 2050 and damage to the global economy similar to the 2008-09 financial crisis.

The tool – called Aware – was launched last year and puts antibiotics into three categories: access, watch and aware. Antibiotics on the access list can be used for common infections. The watch list includes classes of drugs that should only be prescribed in specific circumstances. And on the reserve list are antibiotics that should only be used as a last resort.

WHO recommends that 60 per cent of all the antibiotics prescribed should be on the access list – a goal met by 29 out of 65 countries that track antibiotic data, including the UK.

In 20 countries 50 to 60 per cent of the antibiotics prescribed are on the access list. And in 16 countries less than 50 per cent of antibiotics prescribed are on the access list.

WHO hopes that the new tool will encourage more countries to collect data on consumption of antibiotics in the different categories – an important way  of tackling superbugs.

Dr Mariângela Simão, assistant director general for access to medicines at the WHO, told a press conference at the launch of the campaign that the list also gives countries a clear idea of what are the most essential antibiotics. 

"By putting the most essential antibiotics on the essential medicines list WHO is signalling that these antibiotics should be accessible to those who need them," she said.

"We have evidence showing that increasing the use of the [access] group to at least 60 per cent of national consumption lowers the risk of resistance. But at the same time people get treatment," she said.

Most European countries collect data on appropriate use, alongside the Russian Federation, Canada and a handful of countries in Latin America and Africa.

However, there are some notable exceptions: the United States does not track different categories of antibiotic consumption and neither do populous countries such as India – where superbugs are rife – and China. 

A study of 70 of the richest countries in the Lancet Infectious Diseases journal last year found that high levels of antibiotics on the reserve list were given to children. In a quarter of the countries studied antibiotics on the reserve list accounted for 20 per cent of total consumption.

Professor Hanan Balkhy, assistant director general for AMR at the WHO, said that countries which do not track the appropriateness of antibiotic use were "in the dark".

"It's important that there's a body that analyses that data to understand whether countries are using antibiotics appropriately. 

"Aware is a very simple tool to encourage countries to develop guidelines on antibiotic use," she said. 

Protect yourself and your family by learning more about Global Health Security