World Health Organisation data published on 20 November 2018 shows Tanzania and Burundi among the four highest antibiotic consumers in Africa, underscoring sharp differences in how the medicines are used across the continent.
The figures put Tanzania at 27.3 defined daily doses (DDD) per 1,000 inhabitants per day and Burundi at 4.4 DDD per 1,000 inhabitants per day. Burkina Faso ranked second with 13.8 DDD, while Côte d’Ivoire came third at 10.7 DDD.
In Burundi, penicillins, listed as J01C, made up 78 per cent of antibiotic consumption. The report also found that Burundi stood out from the rest of the countries in the study because injections dominated use there: 76 per cent of antibiotics were injected, while only 24 per cent were taken orally.
Elsewhere, oral medicines accounted for almost all antibiotic use, ranging between 96 and 98 per cent. WHO said the heavy reliance on parenteral formulations in Burundi was likely linked to the fact that hospital consumption was overrepresented in the data.
Among oral antibiotics, amoxicillin, sulfamethoxazole/trimethoprim and ciprofloxacin together accounted for 75 per cent of total oral consumption in Tanzania, Burkina Faso and Côte d’Ivoire. For injected antibiotics, ceftriaxone was the most used in Burkina Faso and Côte d’Ivoire, with an average proportional share of 41 per cent. In Tanzania, gentamicin was the most consumed injectable antibiotic, while Burundi’s highest was benzylpenicillin.
The report said antibiotic use varied widely from country to country, ranging from about four DDD per 1,000 inhabitants per day to more than 64 DDD. WHO said that spread suggests some countries may be overusing antibiotics while others may not have enough access to these life-saving medicines.
Suzanne Hill, director of the Department of Essential Medicines and Health Products at WHO, warned that misuse and overuse are major drivers of antimicrobial resistance. “Overuse and misuse of antibiotics are the leading causes of antimicrobial resistance. Without effective antibiotics and other antimicrobials, we will lose our ability to treat common infections like pneumonia,” she said.
She added that the findings showed the need for urgent action, including prescription-only rules to curb unnecessary use. “Findings from this report confirm the need to take urgent action, such as enforcing prescription-only policies, to reduce unnecessary use of antibiotics,” she said.
WHO said African countries’ total consumption figures were based on wholesaler sales data for 2015, except Tanzania, which provided 2016 data based on imports. Burundi’s information came from the central medical store, which mainly supplies the public sector, including many hospitals, meaning the results largely reflect hospital consumption.
The agency said this was the first time it had compiled antibiotic consumption data for human health care from 65 countries and areas. Overall, the report found that amoxicillin and amoxicillin/clavulanic acid were the most frequently used antibiotics worldwide.
WHO said those medicines are recommended as first- or second-line treatments for common infections and are included in the “Access” category of the WHO Model List of Essential Medicines. In 49 countries, the Access category accounted for more than half of all antibiotic consumption.
