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