Surveillance of Antimicrobial Consumption |
|---|
In Primary Care |
2024 Quarter 4 |
Key Points
The rate of antimicrobial consumption in primary care in Ireland
for the fourth quarter of 2024 was 23.3 defined daily doses (DDD) per
1,000 inhabitants per day (DID). This represents an increase from 23.2
DID in the fourth quarter of the previous year.
This brings the annual rate of antimicrobial consumption in
primary care in Ireland for 2024 to 21.0 DID, representing an increase
from 20.6 DID in 2023.
The most notable increasing trend was among J01A Tetracyclines.
The consumption of J01A Tetracyclines was recorded at 3.0 DID in 2020 in
Ireland. Since then, an increase in this group has been recorded every
year, reaching its highest level in 2024 at 4.3 DID.
There was an increase in the consumption of J01C Penicillins from
2023 to 2024, rising from 10.5 DID in 2023 to 10.7 DID in 2024. Within
J01C antibiotics, the proportion of consumption of J01CA Penicillins
with extended spectrum has been increasing over the years. On the other
hand, broader-spectrum penicillins—J01CR Penicillins in combination with
beta-lactamase inhibitors—have been on a significant decreasing trend.
This indicates that even though the overall consumption of penicillins
increased slightly, there has been a shift towards using
narrower-spectrum penicillins.
There has been a significant increase in the consumption of J01D
Other Beta-Lactam Antibacterials, which include cephalosporins,
monobactams, and carbapenems. Until Q4 of 2022, the consumption of this
group was around 1 DID. In Q4 of 2022, consumption rose sharply to 1.9
DID but dropped to 0.5 DID in the following quarter, Q1 of 2023. Since
then, consumption has remained steady between 0.5 and 0.6 DID. However,
levels have begun returning to their usual range, reaching 1.1 DID in
the fourth quarter of 2024, with the annual rate recorded as 0.8 DID in
2024. The increase between 2023 and 2024 was mainly driven by
first-generation cephalosporins.
The consumption of J01M Quinolones remained relatively stable
between 2020 and 2023. In 2024, the consumption of this group was
recorded at its lowest level, at 0.3 DID, marking a decrease from 0.4
DID in the previous four years.
For the first time, primary care consumption was analyzed using
the WHO’s AWaRe classification. Over the past 10 years, the proportion
of Access group antibiotics has been increasing steadily, reaching
almost 76% in 2024. The EU aims for at least 65% of total antibiotic
consumption in every Member State to come from the Access group, a
target that Ireland has already achieved. In addition, all counties in
Ireland individually met this target, with the consumption of Access
group antibiotics ranging from 74% in Kildare to 79% in
Kilkenny.
The ECDC published its European Surveillance of Antimicrobial
Consumption annual epidemiological report for 2023. In 2023, Ireland
ranked 9th highest among EU/EEA countries in the consumption of J01
antibacterials within the community sector. Even though Ireland’s
consumption was at a mid-to-high level among EU/EEA countries, the
country ranked 2nd highest in terms of Access group antibiotics, after
Denmark.
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 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 WHO introduced the AWaRe classification in 2017 as part of its
Essential Medicines List to support antimicrobial stewardship
activities. This system categorizes antibiotics into three
groups—Access, Watch, and Reserve—to promote their responsible use. To
assess the relative consumption of these categories, the 2023 AWaRe
classification is applied. By 2030, the EU aims for at least 65% of
total antibiotic consumption to come from the Access group in every
Member State.
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 are 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 does
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: Antibiotic Consumption in the Last 10
Years by ATC-3 Groups
Table 1: Antibiotic Consumption in the Last 5 Years
by ATC-3 Groups
ATC-3 Name | 2020 | 2021 | 2022 | 2023 | 2024 |
|---|
J01A Tetracyclines | 3.0 | 3.0 | 3.8 | 3.9 | 4.3 |
J01C Beta-Lactam Antibacterials, Penicillins | 7.3 | 7.2 | 10.4 | 10.5 | 10.7 |
J01D Other Beta-Lactam Antibacterials | 1.0 | 1.0 | 1.3 | 0.5 | 0.8 |
J01E Sunfonamides and Trimethoprim | 1.0 | 0.9 | 0.8 | 0.9 | 0.8 |
J01F Macrolides, Lincosamides and Streptogramins | 2.9 | 2.5 | 3.4 | 3.1 | 3.4 |
J01M Quinolone Antibacterials | 0.4 | 0.4 | 0.4 | 0.4 | 0.3 |
J01X Other Antibacterials | 1.4 | 1.4 | 1.4 | 1.3 | 1.2 |
Total Consumption | 17.1 | 16.3 | 21.5 | 20.6 | 21.6 |
Figure 2: Consumption of Penicillins at ATC Level 4
Subgroup
Figure 3: Consumption of Other Beta Lactam
Antibiotics at ATC level 4 Subgroup
Figure 4: Consumption of J01 Antibacterials by WHO
AWaRe Classification
Seasonal (Quarterly) Results
Figure 5: 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 |
|---|
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 | 21.2 | 19.1 | 19.0 | 23.2 | 20.6 |
2024 | 21.6 | 20.1 | 19.2 | 23.3 | 21.0 |
Figure 6: Quarterly (Seasonal) Consumption of Other
Antimicrobials
Tetracyclines
Figure 7: 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 |
|---|
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 | 4.0 | 3.6 | 3.7 | 4.4 |
2024 | 4.4 | 4.2 | 3.7 | 4.5 |
Penicillins
Figure 8: 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 |
|---|
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 | 10.7 | 9.5 | 9.5 | 12.4 |
2024 | 10.8 | 9.8 | 9.0 | 12.0 |
Other Beta-Lactams
Figure 9: 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 |
|---|
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 | 0.5 |
2024 | 0.6 | 0.6 | 0.9 | 1.1 |
Macrolides
Figure 10: 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 |
|---|
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 | 2.8 | 3.3 |
2024 | 3.2 | 3.3 | 3.2 | 3.4 |
Quinolones
Figure 11: 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 |
|---|
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 | 0.3 | 0.4 |
2024 | 0.4 | 0.3 | 0.3 | 0.3 |
Results by Counties
Figure 12: Overall Antibiotic Consumption in the
Latest Year by County
Figure 13: Consumption of J01 Antibacterials by WHO
AWaRe Classification in the Latest Year by County
Figure 14: Overall Antibiotic Consumption in the
Latest Year by Counties and Month
Tetracyclines
Figure 15: Consumption of Tetracyclines (J01A) in
the Latest Year by County
Penicillins
Figure 16: Consumption of Penicillins (J01C) in the
Latest Year by County
Other Beta-Lactams
Figure 17: Consumption of Other Beta-Lactams (J01D)
in the Latest Year by County
Macrolides
Figure 18: Consumption of Macrolides (J01F) in the
Latest Year by County
Quinolones
Figure 19: Consumption of Quinolones (J01M) in the
Latest Year by County
Results by CHOs and RHAs
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 | 23.0 | 21.3 | 20.5 | 23.9 | 22.2 |
2 | Galway LHO, Roscommon LHO and Mayo LHO | 23.7 | 21.5 | 20.7 | 24.1 | 22.5 |
3 | Clare LHO, Limerick LHO and North Tipperary/East Limerick LHO | 25.0 | 23.7 | 21.9 | 28.0 | 24.7 |
4 | Kerry LHO, North Cork LHO, North Lee LHO, South Lee LHO and West Cork LHO | 20.7 | 20.3 | 19.6 | 23.3 | 21.0 |
5 | South Tipperary LHO, Carlow/Kilkenny LHO, Waterford LHO and Wexford LHO | 23.8 | 22.0 | 20.8 | 25.6 | 23.1 |
6 | Wicklow LHO, Dún Laoghaire LHO and Dublin South East LHO | 23.7 | 22.2 | 20.2 | 25.1 | 22.8 |
7 | Kildare/West Wicklow LHO, Dublin West LHO, Dublin South City LHO and Dublin South West LHO | 18.3 | 16.8 | 16.3 | 19.9 | 17.8 |
8 | Laois/Offaly LHO, Longford/Westmeath LHO, Louth LHO and Meath LHO | 21.5 | 20.1 | 19.4 | 24.1 | 21.2 |
9 | Dublin North LHO, Dublin North Central LHO and Dublin North West LHO | 18.7 | 16.8 | 16.5 | 19.7 | 17.9 |
Table 9: Overall Antibiotic Consumption in the
Latest Year by RHAs
RHA | HSE Area | Q1 | Q2 | Q3 | Q4 | Rate |
|---|
Area A | HSE Dublin & NE | 19.3 | 17.6 | 17.2 | 21.1 | 18.8 |
Area B | HSE Dublin & Midlands | 20.3 | 18.9 | 18.2 | 22.1 | 19.9 |
Area C | HSE Dublin & SE | 23.4 | 21.7 | 20.3 | 25.0 | 22.6 |
Area D | HSE SW | 20.7 | 20.3 | 19.6 | 23.3 | 21.0 |
Area E | HSE MW | 25.0 | 23.7 | 21.9 | 28.0 | 24.7 |
Area F | HSE W & NW | 23.5 | 21.5 | 20.6 | 23.8 | 22.4 |
Monthly Comparison
Tetracyclines
Figure 20: Consumption of Tetracyclines (J01A) in
the Last 2 Years by Month
Penicillins
Figure 21: Consumption of Penicillins (J01C) in the
Last 2 Years by Month
Other Beta-Lactams
Figure 22: Consumption of Other Beta Lactam
Antibiotics (J01D) in the Last 2 Years by Month
Macrolides
Figure 23: Consumption of Macrolides (J01F) in the
Last 2 Years by Month
Quinolones
Figure 24: Consumption of Quinolones (J01M) in the
Last 2 Years by Month
International Comparison
Figure 25: Antimicrobial Consumption in the
Community Sector Among EU/EAA Member States in 2023
