A new study has discovered that the largest increases are in low-income and middle-income countries, and calls for strategies to reduce use and support alternatives.

In SA consumption of antibiotics has increased by 99.5%.

Despite the threat of a global health crisis in antibiotic resistance, worldwide use of antibiotics soared 39% between 2000 and 2015, fuelled by dramatic increases in low-income and middle-income countries (LMICs), according to a new study in the Proceedings of the National Academy of Sciences (PNAS).

The study, which analysed human antibiotic consumption in 76 countries, is the most comprehensive assessment of global trends to date. Researchers from the Center for Disease Dynamics, Economics, and Policy (CDDEP), Princeton University, ETH Zurich, and the University of Antwerp conducted the study, which found that antibiotic consumption rates increased worldwide from 11.3 to 15.7 defined daily doses (DDDs) per 1 000 inhabitants per day between 2000 and 2015.

Antibiotic resistance is a global health problem; when it emerges in one place, it quickly spreads to other parts of the world. The study underscores the need for consistent global surveillance of antibiotic resistance and policies to curtail unnecessary antibiotic use.

Loss of effective antibiotics is driven in large part by antibiotic consumption, most of which is inappropriate and does nothing to improve health. However, while reducing antibiotic use is critical, increasing access to antibiotics in lower-income countries is also necessary, as these countries suffer from the highest rates of illness and death caused by infectious disease, the study researchers pointed out.

“SA has a unique challenge in that it suffers from a quadruple burden of drug resistant infectious diseases; HIV, tuberculosis, malaria, and antimicrobial resistance,” says Dr Yogan Pillay, acting director general for the National Department of Health. “Balancing access to life-saving antibiotics whilst curbing inappropriate use are daily challenges in our health care settings.”

“This important publication shows that SA’s levels of antibiotic use are sky-high, with almost 100% increase between 2000 and 2015 and this is the driving force behind the devastating increase in common bacterial infections that are resistant to the antibiotics in this country,” says Professor Marc Mendelson, chair of the Ministerial Advisory Committee on Antimicrobial Resistance for SA.

“Turning the tide on resistance will require partnership between all members of the public, prescribers, and the government to change our behaviour. Withholding antibiotics for symptoms and illnesses where they are not needed, coupled with reducing the need for an antibiotic in the first place by vaccinating our children, improving access to clean water and safe sanitation, and ensuring good hand hygiene in our health care facilities and in the home, are major interventions that we all need to share in, ” said Prof Mendelson.

“Finding workable solutions is essential, and we now have key data needed to inform those solutions,” said CDDEP researcher and study co-author Eili Klein. “Now, more than ever, we need effective interventions, including stewardship, public education, and curbing overuse of last-resort antibiotics.”