Consumption of systemic antibiotics in a tertiary care hospital in Northern Sri Lanka: a five-year trend analysis

Abstract

Background Surveillance of antimicrobial consumption helps to understand the pattern of antibiotic utilisation and plays an essential role in tackling antimicrobial resistance. However, a lack of an established surveillance system is a major challenge in combating antimicrobial resistance in low- and middle-income countries (LMICs). This study aimed to determine the pattern of systemic antibiotic consumption at the Teaching Hospital, Jaffna, using the World Health Organization (WHO) methodology for surveillance of antimicrobial consumption. Methods A descriptive study of systemic antibiotic consumption was conducted at the Teaching Hospital, Jaffna, from 2018 to 2022. Supply data were analysed using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Antibiotic consumption volume was expressed in DDD, while outpatient and inpatient consumption rates were expressed as DDD/100 patients and DDD/100 admissions, respectively. The AWaRe (Access, Watch, and Reserve) classification and Drug Utilisation-90% (DU90%) were used to assess consumption patterns. Trends were assessed using curve estimation analysis. The Wilcoxon signed-rank test and Friedman test were performed to determine the significance of changes between years and over five years, respectively. A p value ≤ 0.05 was considered statistically significant. Results Compared with 2018, overall antibiotic consumption showed a declining trend except in 2019. Oral antibiotics accounted for more than 80% of total consumption, and amoxicillin/clavulanic acid remained the most commonly consumed antibiotic. Access antibiotics accounted for over 70% of total consumption, with an Accessto- Watch ratio > 2 throughout the study period. The DU90% segment remained largely consistent, comprising 11–12 antibiotics. Curve estimation analysis showed non-linear trends in Access and Watch antibiotic consumption. Despite the decline in total antibiotic consumption, the inpatient antibiotic consumption significantly increased in 2021 compared with 2020 (p < 0.001). Conclusion Analysis of antibiotic supply data showed that the overall pattern of antibiotic consumption remained consistent over a five-year period despite the changes that occurred during the COVID-19 pandemic. Establishing routine monitoring of antibiotic consumption using available data sources in hospitals provides basic information and insights into the problems. These findings could help to plan strategies to improve the antibiotic utilisation in LMICs.