EU/EEA during COVID-19 pandemic: Largest annual decrease in antibiotic use in the community in two decades

On the occasion of European Antibiotic Awareness Day (EAAD) on 18 November and the start of World Antibiotic Awareness Week, new data from the European Centre for Diseases Prevention and Control (ECDC) published in Eurosurveillance show that antibiotic consumption in the community decreased by more than 18% between 2019 and 2020 [1].

This decline, noted by the authors as the largest annual decrease in the two decades of reporting via the European Surveillance of Antimicrobial Consumption Network (ESAC-Net), was observed in 26 of the 27 reporting countries of the European Union and European Economic Area (EU/EEA). Changes were largest and most consistent in the primary care sector, most likely as a result of the COVID-19 pandemic.

In the rapid communication published today in Eurosurveillance, Diaz Högberg et al. analysed the consumption of antibacterials for systemic use. From 2016 and 2019, the EU/EEA population-weighted mean annual change in the consumption of antibacterials for systemic use was −0.34 defined daily doses (DDD) per 1,000 inhabitants per day, representing a 1.8% annual decrease (median: −0.44 DDD/1,000 inhabitants/day or a 2.3% annual decrease). Between 2019 and 2020, the decrease was ten times higher, declining by −3.35 DDD/1,000 inhabitants/day. This represents a 18.3% decrease between 2019 and 2020 [2].

Overall decline in consumption of penicillins and beta-lactams
The 26 countries that reported an overall decrease in consumption of antibacterials showed a decline in consumption of penicillins between 2019 and 2020, as well as reduced consumption of other beta-lactams (including cephalosporins, macrolides, lincosamides and streptogramins).  

According to the authors, possible reasons for the decrease could be a general drop in the number of primary care consultations during the COVID-19 pandemic, as people were more cautious to seek healthcare for mild or self-limiting infections, or due to difficulties in getting medical appointments.

The authors also hypothesise that ‘the large decrease noted for antibiotics commonly used to treat respiratory tract infections, e.g. penicillins and other beta-lactam antibacterials, is in line with the reported low incidence of non-COVID-19-related respiratory tract infections in the EU/EEA in 2020. This has been attributed to the non-pharmaceutical interventions put in place as a response to the pandemic, including physical distancing, respiratory etiquette, face masks and promotion of hand hygiene.’

As exposure to antibiotics is associated with the emergence of antibiotic resistance, the overall uptake and how antibiotics are consumed in a population has an impact on antibiotic resistance. Prior to the COVID-19 pandemic, the primary care sector accounted for about 80% to 90% of all antibiotic prescriptions, mainly for respiratory tract infections [3].

Diaz Högberg et al. note that it remains to be seen if the decline in antibiotic consumption in the community observed in 2020 will be sustained throughout 2021 and what implications the recent decrease may have on antimicrobial resistance in Europe overall.
 

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References/notes to editors:
[1] Diaz Högberg L, Vlahović-Palčevski V, Pereira C, Weist K, Monnet CL, ESAC-Net study group. Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020. Euro Surveill. 2021;26(46):2101020. Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.46.2101020

[2] Analyses based on data reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net), collected using a described methodology and expressed as defined daily doses (DDD) per 1,000 inhabitants per day, using the Anatomical Therapeutic Chemical (ATC) Index for 2021. More on antimicrobial consumption and the  https://www.ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database.

[3] Factsheet for primary care prescribers, ECDC. Available from: https://antibiotic.ecdc.europa.eu/sites/default/files/media/en/eaad/Documents/antibiotics-factsheet-primary-care-prescribers.pdf

[4] European Antibiotic Awareness Day
European Antibiotic Awareness Day (EAAD) is a European health initiative coordinated by ECDC, which provides a platform and support for national campaigns on the prudent use of antibiotics. Each year, EAAD is marked by national campaigns on or around 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course. Please visit http://antibiotic.ecdc.europa.eu for more information and follow the discussion on social media. Follow the hashtags #EAAD #AntibioticResistance #KeepAntibioticsWorking

[5] World Antimicrobial Awareness Week
In 2021, the World Antimicrobial Awareness Week (WAAW) – a WHO initiative – will take place between 18 and 24 November. Follow the hashtags #WAAW #AntimicrobialResistance #AMR #HandleWithCare and see http://www.who.int/campaigns/world-antibiotic-awareness-week/en/ for more information.

[6) More on antimicrobial consumption and resistance in this week’s Eurosurveillance issue (online late afternoon CET on 18 November 2021): https://www.eurosurveillance.org/content/eurosurveillance/26/46 
Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018
Stefanie, Baty Florent, Albrich Werner C, Babouee Flury Baharak, Gasser Michael, Plüss-Suard Catherine, Schlegel Matthias, Kronenberg Andreas, Kohler Philipp, on behalf of the Swiss Centre for Antibiotic Resistance (ANRESIS)
Euro Surveill. 2021;26(46):pii=2001537. https://doi.org/10.2807/1560-7917.ES.2021.26.46.2001537

Staphylococcus aureus bloodstream infections: diverging trends of meticillin-resistant and meticillin-susceptible isolates, EU/EEA, 2005 to 2018
Gagliotti Carlo, Högberg Liselotte Diaz, Billström Hanna, Eckmanns Tim, Giske Christian G, Heuer Ole E, Jarlier Vincent, Kahlmeter Gunnar, Lo Fo Wong Danilo, Monen Jos, Murchan Stephen, Simonsen Gunnar Skov, Šubelj Maja, Andrašević Arjana Tambić, Żabicka Dorota, Žemličková Helena, Monnet Dominique L, EARS-Net study group participants
Euro Surveill. 2021;26(46):pii=2002094. https://doi.org/10.2807/1560-7917.ES.2021.26.46.2002094