Detailed, longitudinal data on human antibiotic consumption are crucial to determine the drivers of AMR. A recent report provides an overview and analysis of such data for the WHO European region over 2014-2018.

Despite finding that the mean total consumption of antibacterials for systemic use in humans was similar across the countries and datasets, they found substantial heterogeneity in this total between countries (~9-34 defined daily doses (DDD) per 1,000 inhabitants per day). Moreover, there was substantial variation in the antibiotics comprising this total and in the use of different AWaRE classification antibiotics. Eight countries had statistically significant decreasing trends, whilst three had significantly increasing trends in total use over time.

This variation in antibiotic consumption provides an insight into how selective pressure, and hence AMR evolution, has a national organisation due to our health system structure. For example, the dominant clones of methicillin resistant S. aureus have clear country associations. Despite our understanding of the global nature of AMR and gene spread, such country level differences in selective pressures will surely affect AMR evolution. Getting to the bottom of these differences and comparing strain collections between countries is now needed to understand the contribution of this human consumption heterogeneity to AMR.

This data is likely to be some of the best available for antibiotic consumption, collected by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe, and yet there are still limitations such as only the inclusion of antibiotics with an ATC code and assigned DDD, differences in data sources and a lack of setting specific segregation (e.g. community vs hospital, urban vs rural use).

The conclusions of this report suggest that indicators which measure total consumption alone are inadequate to assess a country’s performance and that targets for percentage use of antibiotics from the Access criteria could be increased for settings with comprehensive programmes to address AMR. Future work into understanding how and where this reported heterogeneity links to variation in AMR prevalence is fundamental for the next steps in AMR containment strategies.