Antibiotic consumption in Europe rebounds to pre-pandemic levels

This 12 months’s European Antibiotic Awareness Day (EAAD) focuses on the targets outlined within the 2023 Council Advice to step up efforts within the European Union (EU) against antimicrobial resistance in a One Health approach. Those recommendations formulate the 2023 goal to scale back total antibiotic consumption (community and hospital sectors combined) by 20%, using consumption data from 2019 as baseline.

Consumption of antibiotics locally accounts for around 90% of the entire use. This implies, that a considerable and consistent decline in using antibiotics on this sector will probably be key on the best way towards reaching the set goals for 2030 which aim at stopping and reducing antimicrobial resistance overall.

Through the first 12 months 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 using non-pharmaceutical interventions (e.g. physical distancing or wearing of face masks) which reduced overall spread of pathogens, and to the proven fact that prescriptions of antibiotics were affected by the disrupted access to healthcare services through the first 12 months of the pandemic.

Unusual fluctuation between 2019 and 2022

Of their rapid communication published in Eurosurveillance on the occasion of EAAD and World AMR Awareness Week, Ventura-Gabarró et al. present most up-to-date data reported to the European Surveillance of Antimicrobial Consumption Network. They show that the observed decrease from 2020 didn’t last.

As an alternative, together 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 locally sector moved antibiotic consumption rates back towards the 2019 baseline value.

The information 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 a median increase of 8.4% amongst 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 simply a marginal (lower than +/−3%) change in antibiotic consumption locally. Between 2021 and 2022 pre-pandemic levels of 2019 were reached again with a median increase of 20.5%.

The authors highlight that “although the resurgence of each viral and bacterial respiratory tract infections through the latter a part of our study period might partly explain this rebound in antibiotic consumption, the rise could also reflect a missed opportunity to strengthen and reinforce prudent antibiotic use.” They conclude that “the COVID-19-pandemic had a considerable impact on community antibiotic consumption within 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 behaviors for specific antibiotic groups can inform effective stewardship interventions and convey the EU/EEA closer to its antibiotic consumption targets for 2030.”