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Environmental information systems
Key message: Human consumption of antibacterial medication in the EU largely rebounded to pre-pandemic levels in 2022 and 2023, following a drop in their intake between 2019 and 2020. This renews concerns about antimicrobial resistance.
Total consumption of antibacterial medication for systemic use (community and hospital sectors combined), EU Member States*, 2018-2023
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The European Surveillance of Antimicrobial Consumption Network (ESAC-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC), collects national annual sales and reimbursement data on the consumption of antimicrobial medication — including antibiotics — in EU and European Economic Area (EEA) countries.
In 2023, consumption of antibacterial medication – antibiotics – in the EU decreased by 1.5% compared to 2018, from 20.1 to 19.8 defined daily doses (DDD) per 1,000 inhabitants per day. In contrast, consumption fell by 17% between 2018 and 2021 before significantly increasing between 2021 and 2023, reflecting a rebound after the COVID-19 pandemic. Similarly, total EU sales of antibacterials for human use rose between 2021 and 2023.
Pharmaceutical legislation proposed under the Pharmaceutical Strategy for Europe aims to introduce measures to restrict and optimise the use of antimicrobial medicines. Combined with promoting more prudent use of antibiotics by both doctors and patients, these measures would help reduce antibacterial consumption. Lowering the intake of such drugs would help decrease the risk of antimicrobial resistance in humans, which causes more than 35,000 deaths annually in EU and EEA countries. It would also help reduce the use of substances that have toxic properties for the environment, such as sulfamethoxazole and trimethoprim found for example in antibiotics to treat urinary tract and ear infections.
Please consult the relevant indicators and signals below for a more comprehensive overview on the topic.
Consumption of antibacterials for systemic use expressed as ‘defined daily doses (DDD) per 1,000 inhabitants per day’ has been selected as the primary harmonised outcome indicator by the ECDC, the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA) to describe total antimicrobials consumption by the EU population (considering both adults and children).
Total sales in tonnes are also included in the indicator to represent the total environmental pressure as compared to the relative pressure by inhabitants.
The data presented are crude means of the national DDD per 1,000 inhabitants per day and sums of total sales in tonnes.
Antimicrobials are grouped according to the anatomical therapeutic chemical (ATC) classification while ‘defined daily doses’ (DDD) are determined by the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology and available from the ATC/DDD Index. The total consumption indicator combines both community and hospital consumption of antibacterials for systemic use, corresponding to the ATC group J01. For this group, data completeness and consistency allow for analysis across countries and years.
A few countries do not report consumption data from the hospital sector. However, community consumption has been shown to be a representative sample of around 90% of the total consumption for this group (community and hospital sectors combined) when expressed as DDD per 1,000 inhabitants per day.
ESAC-Net data are reported either as 1) national antimicrobial consumption (AMC) data at the medicinal product level as number of packages sold or reimbursed (national registry of antimicrobials data), or 2) as national AMC data at ATC substance level as an aggregated number of DDD per 1,000 inhabitants per day. While reimbursement data do not include antimicrobials provided without a prescription and non-reimbursed prescribed antimicrobials, sales data may overestimate the AMC level. For more information, see the data source overview in ECDC AMC dashboard.
Relevant objectives under the Chemicals Strategy for Sustainability
Minimise exposure of humans and environment to substances hazardous to health and the environment, through risk management measures and full information to users of chemicals
Restore human health and environment to a good quality status
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Other relevant indicators and signals
References and footnotes
- ↵ECDC, 2022, Antimicrobial consumption in the EU/EEA (ESAC-Net), Annual Epidemiological Report 2021, European Centre for Disease Prevention and Control, Stockholm, Sweden (https://www.ecdc.europa.eu/sites/default/files/documents/ESAC-Net_AER_2021_final-rev.pdf) accessed 21 December 2022.
- ↵ECDC, 2023, Antimicrobial consumption in the EU/EEA (ESAC-Net), Annual Epidemiological Report for 2022, European Centre for Disease Prevention and Control, Stockholm, Sweden (https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-consumption-europe-2022) accessed 18 December 2023.
- ↵EC, 2020, Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions ‘Pharmaceutical Strategy for Europe' (COM/2020/761 final) (https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52020DC0761&from=EN) accessed 15 February 2023.
- ↵European Centre for Disease Prevention and Control., 2022, Assessing the health burden of infections with antibiotic-resistant bacteria in the EU/EEA, 2016-2020., Publications Office, LU.
- ↵2022, Commission Implementing Decision (EU) 2022/1307 of 22 July 2022 establishing a watch list of substances for Union-wide monitoring in the field of water policy pursuant to Directive 2008/105/EC of the European Parliament and of the Council (notified under document C(2022) 5098) (Text with EEA relevance) (OJ L 197, 26.7.2022, p. 117–120).
- ↵ECDC, et al., 2017, 'ECDC, EFSA and EMA Joint Scientific Opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food‐producing animals', EFSA Journal 15 (10).
- ↵EMA, ESVAC, 2023, Sales of veterinary antimicrobial agents in 31 European countries in 2022, European Medicines Agency, Amsterdam, the Netherlands.
- ↵EFSA, et al., 2021, Antimicrobial consumption and resistance in bacteria from humans and animals: third joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA, JIACRA III 2016-2018, Publications Office of the European Union, Luxembourg.