Antibiotic Consumption in the State Sector of Sri Lanka Over 25 Years: 1994 - 2018 Using the GAP Methodology

Abstract

Purpose: Surveillance of antibiotic consumption is one of the five pillars of the World Health Organizations global action plan to combat antimicrobial resistance. This study determined the feasibility of using the WHO-GAP methodology to develop a sustainable Antimicrobial Medicines Consumption (AMC) monitoring system in Sri Lanka. The aggregated distribution data (1994 – 2018) in the State sector was used to test feasibility and incite interest. Methods: Aggregated data on J01 defined as antibacterials for systemic use, distributed to the State sector from 1994 to 2018 were extracted from the database of the Medical Supplies Division, Ministry of Health. The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose methodology was used to calculate the total consumption as DDDs per 1000 inhabitants per day (DID), relative use measures (percentages), and extent of use of WHO Access, Watch and Reserve group antibiotics. Results: Antibiotic consumption increased from 6.79 DID in 1994 to 13.89 DID in 2018 with the number of chemical substances increasing from 19 to 41 respectively. The most consumed was J01C (beta-lactam antibacterials) while the largest increase in rate of consumption was seen in J01D (other beta-lactam antibacterials). From 2008 the top ten oral and parenteral antibiotics showed a significant shift to broad spectrum from narrow spectrum with their ratio increasing from 0.19 to 2.37, due to predominant consumption of cefuroxime, ceftriaxone and co-amoxiclav. Consumption of the RESERVE group though low is rapidly increasing with time. Conclusion: This paper provides the Ministry of Health the impetus and direction to begin a sustainable monitoring system to track trends and drivers of AMC in Sri Lanka.