Key Points

  • The rate of antimicrobial consumption in primary care in Ireland for the third quarter of 2023 (Q3 2023) is 19.3 defined daily doses (DDD) per 1000 inhabitants per day (DID). This compares with 19.4 DID in the previous quarter (Q2 2023) and 21.6 DID in Q1 2023. It marks the highest level for the third quarter of the year in the last 5 years.

  • The overall rate to date in 2023 (Q1, Q2, and Q3 combined) is observed as 20.1 DID. A significant reduction in the consumption of antibiotics was noted during the COVID-19 pandemic, with 17.1 and 16.3 DIDs reported in 2020 and 2021, respectively. However, data from 2022 and 2023 show that consumption has now increased back to pre-pandemic levels.

  • There has been a notable decrease in the consumption of J01D Other Beta-Lactam Antibacterials. This group refers to cephalosporin, monobactam, and carbapenem group antibiotics. The consumption for J01D antibiotics was 1.2 in 2019, decreasing to 1.0 DID during the pandemic years (2020 and 2021). Even though the consumption increased back to 1.3 DID in 2022, in 2023, the consumption of J01D antibiotics is even lower than the pandemic years at 0.5 DID.

  • Westmeath, Carlow, Mayo, Limerick, and Longford were the top 5 counties in terms of overall antibiotic consumption in 2023, while Dublin, Clare, Wicklow, Meath, and Roscommon took the last 5 places.


Methodology

Background

Antimicrobial consumption is the main driver of antimicrobial resistance. Therefore antimicrobial consumption surveillance is important to identify potential over and inappropriate use of antimicrobial agents.

ATC/DDD Methodology

Irish antimicrobial sales data are obtained from IQVIA (formerly IMS Health), a pharmaceutical market research company. This dataset contains regional, monthly wholesaler-to-community pharmacy sales data from over 95% of the wholesalers and manufacturers in Ireland.

Consumption is measured as defined daily dose (DDD), which is the assumed average maintenance dose per day for a drug used for its main indication in adults. The WHO Anatomical Therapeutic Chemical (ATC) index is used to categorise antimicrobial agents. The ATC/DDD system is recommended by WHO as the international standard for drug utilization studies and it serves as a tool for drug utilization monitoring and research in order to improve quality of drug use. More information on ATC/DDD Methodology can be found on WHO’s website.

Consumption rates are calculated as DDD per 1000 inhabitants per day (DID). Eurostat yearly population estimates are used for national rates. Central Statistics Office 2022 Census results are proportionated with Eurostat population to calculate the county rates. The underlying trend on the quarterly graph is derived by using local regression of seasonal results.

The European Surveillance of Antimicrobial Consumption Network (ESAC-Net) is managed by the European Centre for Disease Prevention and Control (ECDC) and the network uses the same methodology. The country rates for the EU Member States is obtained from ECDC’s ESAC-Net Dashboard. More information on ESAC-Net can be found on ECDC’s website.

Limitations

Although the IQVA database used in this report is very comprehensive, there are some limitations. The data are based on pharmacy wholesale data, rather than on individual prescriptions. Thus it cannot be used to determine the actual number of antimicrobial courses taken and do not provide information on dose or duration of therapy. Factors such as stockpiling of antimicrobials in pharmacies and drug wastage (e.g. passing the sell-by date) may introduce biases. Likewise, recent changes to prescribing guidelines, that recommend using higher doses may lead to an increase in consumption (as measured by DDD/1000 inhabitants/day), while the total number of prescriptions may have remained static or even declined.


Main Results


Figure 1: Antimicrobial Consumption in the Last 10 Years by ATC-3 Groups



Table 1: Antimicrobial Consumption in the Last 5 Years by ATC-3 Groups


ATC-3 Name

2019

2020

2021

2022

2023

J01A Tetracyclines

3.0

3.0

3.0

3.8

3.8

J01C Beta-Lactam Antibacterials, Penicillins

10.0

7.3

7.2

10.4

10.0

J01D Other Beta-Lactam Antibacterials

1.2

1.0

1.0

1.3

0.5

J01E Sunfonamides and Trimethoprim

1.0

1.0

0.9

0.8

0.9

J01F Macrolides, Lincosamides and Streptogramins

3.9

2.9

2.5

3.4

3.1

J01M Quinolone Antibacterials

0.6

0.4

0.4

0.4

0.4

J01X Other Antibacterials

1.4

1.4

1.4

1.4

1.3

Total Consumption

21.0

17.1

16.3

21.5

20.1


Seasonal (Quarterly) Results


Figure 2: Quarterly (Seasonal) Consumption of Antibiotics in the Last 10 Years



Table 2: Quarterly (Seasonal) Consumption of Antibiotics in the Last 5 Years


Year

Q1

Q2

Q3

Q4

Rate

2019

22.2

19.4

18.4

24.1

21.0

2020

25.3

12.8

14.6

15.7

17.1

2021

13.8

14.3

16.1

21.0

16.3

2022

18.7

19.9

18.2

29.1

21.4

2023

21.6

19.4

19.3

20.1


Tetracyclines


Figure 3: Consumption of Tetracyclines (J01A) in the Last 10 Years by Quarters



Table 3: Consumption of Tetracyclines (J01A) in the Last 5 Years by Quarters


Year

Q1

Q2

Q3

Q4

2019

2.9

2.9

2.7

3.4

2020

3.9

2.5

2.6

2.9

2021

2.7

2.8

2.6

3.7

2022

3.8

3.8

3.1

4.6

2023

4.1

3.7

3.8


Penicillins


Figure 4: Consumption of Penicillins (J01C) in the Last 10 Years by Quarters



Table 4: Consumption of Penicillins (J01C) in the Last 5 Years by Quarters


Year

Q1

Q2

Q3

Q4

2019

10.8

9.1

8.5

11.7

2020

12.1

4.8

6.1

6.4

2021

5.5

6.0

7.4

10.0

2022

8.3

9.2

8.7

15.2

2023

10.9

9.6

9.6


Other Beta-Lactams


Figure 5: Consumption of Other Beta-Lactams (J01D) in the Last 10 Years by Quarters



Table 5: Consumption of Other Beta-Lactams (J01D) in the Last 5 Years by Quarters


Year

Q1

Q2

Q3

Q4

2019

1.2

1.1

1.0

1.4

2020

1.2

0.8

0.9

1.0

2021

0.8

0.8

0.9

1.2

2022

1.1

1.2

1.1

1.9

2023

0.5

0.5

0.5


Macrolides


Figure 6: Consumption of Macrolides (J01F) in the Last 10 Years by Quarters



Table 6: Consumption of Macrolides (J01F) in the Last 5 Years by Quarters


Year

Q1

Q2

Q3

Q4

2019

4.2

3.4

3.2

4.6

2020

4.9

2.1

2.1

2.5

2021

2.1

2.2

2.4

3.3

2022

2.9

3.2

2.8

4.6

2023

3.3

3.0

2.9


Quinolones


Figure 7: Consumption of Quinolones (J01M) in the Last 10 Years by Quarters



Table 7: Consumption of Quinolones (J01M) in the Last 5 Years by Quarters


Year

Q1

Q2

Q3

Q4

2019

0.6

0.5

0.5

0.5

2020

0.5

0.4

0.4

0.4

2021

0.4

0.3

0.4

0.4

2022

0.4

0.4

0.4

0.4

2023

0.4

0.4

0.4

Results by Counties


Figure 8: Overall Antibiotic Consumption in the Latest Year by Counties


Figure 9: Overall Antibiotic Consumption in the Latest Year by Counties and Month


Tetracyclines


Figure 10: Consumption of Tetracyclines (J01A) in the Latest Year by Counties



Penicillins


Figure 11: Consumption of Penicillins (J01C) in the Latest Year by Counties



Other Beta-Lactams


Figure 12: Consumption of Other Beta-Lactams (J01D) in the Latest Year by Counties



Macrolides


Figure 13: Consumption of Macrolides (J01F) in the Latest Year by Counties



Quinolones


Figure 14: Consumption of Quinolones (J01M) in the Latest Year by Counties


Results by CHOs


Table 8: Overall Antibiotic Consumption in the Latest Year by CHO Areas


CHO Area

LHO Area

Q1

Q2

Q3

Q4

Rate

1

Donegal LHO, Sligo/Leitrim/West Cavan LHO and Cavan/Monaghan LHO

22.2

20.2

20.0

20.8

2

Galway LHO, Roscommon LHO and Mayo LHO

22.8

20.9

21.5

21.7

3

Clare LHO, Limerick LHO and North Tipperary/East Limerick LHO

25.4

22.0

22.2

23.2

4

Kerry LHO, North Cork LHO, North Lee LHO, South Lee LHO and West Cork LHO

21.9

19.9

20.7

20.8

5

South Tipperary LHO, Carlow/Kilkenny LHO, Waterford LHO and Wexford LHO

23.5

20.5

20.4

21.4

6

Wicklow LHO, Dún Laoghaire LHO and Dublin South East LHO

23.2

21.1

20.1

21.5

7

Kildare/West Wicklow LHO, Dublin West LHO, Dublin South City LHO and Dublin South West LHO

18.5

16.4

16.3

17.1

8

Laois/Offaly LHO, Longford/Westmeath LHO, Louth LHO and Meath LHO

21.5

19.8

19.5

20.2

9

Dublin North LHO, Dublin North Central LHO and Dublin North West LHO

19.9

18.0

17.0

18.3


Monthly Comparison


Tetracyclines


Figure 15: Consumption of Tetracyclines (J01A) in the Last 2 Years by Month



Penicillins


Figure 16: Consumption of Penicillins (J01C) in the Last 2 Years by Month


Other Beta-Lactams


Figure 17: Consumption of Other Beta Lactam Antibiotics (J01D) in the Last 2 Years by Month


Macrolides


Figure 18: Consumption of Macrolides (J01F) in the Last 2 Years by Month


Quinolones


Figure 19: Consumption of Quinolones (J01M) in the Last 2 Years by Month



International Comparison


Figure 20: Antimicrobial Consumption in the EU Member States in 2022