Surveillance of Antimicrobial Consumption |
|---|
In Primary Care |
2025 Quarter 1 |
Key Points
The rate of antimicrobial consumption in primary care in Ireland
for the first quarter of 2025 was 21.6 defined daily doses (DDD) per
1,000 inhabitants per day (DID), remaining stable compared to 21.6 DID
in the same quarter of the previous year.
The most notable increasing trend in recent years was observed in
J01A Tetracyclines. In 2020, the consumption of this group in Ireland
was 3.0 DID. Since then, it has shown a consistent annual increase,
reaching 4.5 DID in the first quarter of 2025. This rise is primarily
driven by doxycycline, while the use of other tetracyclines has remained
relatively stable. The increased use of doxycycline is believed to be
influenced by its classification as a “green” agent in the AMRIC
Green/Red Classification, its recommended use for certain respiratory,
its role in acne treatment, and its recent use as doxyPEP.
The consumption of J01C Penicillins decreased slightly from 10.8
DID in the first quarter of 2024 to 10.6 DID in the first quarter of
2025. Within this group, the proportion of J01CA Penicillins with
extended spectrum has been steadily increasing over the years. In
contrast, broader-spectrum penicillins—specifically J01CR Penicillins in
combination with beta-lactamase inhibitors—have shown a significant
downward trend, which continued in the first quarter of 2025. The
relative consumption of penicillin/beta-lactamase inhibitor combinations
within the J01C group decreased to 25%, down from 27% in the previous
year. Meanwhile, the share of extended-spectrum plain penicillins
increased to 57%, up from 52%. This aligns with the AMRIC Green/Red
Classification, which prefers the use of plain amoxicillin over the use
amoxicillin/clavulanic acid combination.
The consumption of J01M Quinolones, J01F Macrolides, Lincosamides
and Streptogramins and J01E Sulfonamides and Trimethoprim remained
relatively stable between 2022 and 2025 with no significant
trend.
There has been a further increase in the consumption of Access
group antibiotics in the first quarter of 2025. The consumption of
Access group antibiotics was around 74 to 75 % in recent years and it
reach to almost 78 % in the first quarter of 2025. However, while the
increase in green and access agents is a positive development, the
overall consumption of antibiotics in Ireland in recent years has been
very stable around 20 to 21 DIDs and it is above the EU average. Ireland
ranked 9th highest among EU/EEA countries in the consumption of J01
antibacterials within the community sector in 2024.
The EU Council, based on 2019 consumption rates, has set a 27%
reduction target for Ireland’s overall antibiotic consumption by 2030.
This means that Ireland must reduce its total antibiotic consumption
(combining both hospital and primary care sectors) to 16.6 DID within
the next five years. Achieving this target will be a significant
challenge and will require sustained, coordinated efforts across the
healthcare system.
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 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|
J01A Tetracyclines | 3.0 | 3.8 | 3.9 | 4.2 | 4.5 |
J01C Beta-Lactam Antibacterials, Penicillins | 7.2 | 10.4 | 10.5 | 10.4 | 10.6 |
J01D Other Beta-Lactam Antibacterials | 1.0 | 1.3 | 0.5 | 0.8 | 1.1 |
J01E Sulfonamides and Trimethoprim | 0.9 | 0.8 | 0.9 | 0.8 | 0.8 |
J01F Macrolides, Lincosamides and Streptogramins | 2.5 | 3.4 | 3.1 | 3.3 | 3.2 |
J01M Quinolone Antibacterials | 0.4 | 0.4 | 0.4 | 0.3 | 0.3 |
J01X Other Antibacterials | 1.4 | 1.4 | 1.3 | 1.2 | 1.1 |
Total Consumption | 16.3 | 21.5 | 20.6 | 21.0 | 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 |
|---|
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 |
2025 | 21.6 |
|
|
| 21.6 |
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 |
|---|
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 |
2025 | 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 |
|---|
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 |
2025 | 10.6 |
|
|
|
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 |
|---|
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 |
2025 | 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 |
|---|
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 |
2025 | 3.2 |
|
|
|
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 |
|---|
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 |
2025 | 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 | 22.5 |
|
|
| 22.5 |
2 | Galway LHO, Roscommon LHO and Mayo LHO | 22.6 |
|
|
| 22.6 |
3 | Clare LHO, Limerick LHO and North Tipperary/East Limerick LHO | 26.0 |
|
|
| 26.0 |
4 | Kerry LHO, North Cork LHO, North Lee LHO, South Lee LHO and West Cork LHO | 22.6 |
|
|
| 22.6 |
5 | South Tipperary LHO, Carlow/Kilkenny LHO, Waterford LHO and Wexford LHO | 23.3 |
|
|
| 23.3 |
6 | Wicklow LHO, Dún Laoghaire LHO and Dublin South East LHO | 23.6 |
|
|
| 23.6 |
7 | Kildare/West Wicklow LHO, Dublin West LHO, Dublin South City LHO and Dublin South West LHO | 18.3 |
|
|
| 18.3 |
8 | Laois/Offaly LHO, Longford/Westmeath LHO, Louth LHO and Meath LHO | 22.6 |
|
|
| 22.6 |
9 | Dublin North LHO, Dublin North Central LHO and Dublin North West LHO | 19.1 |
|
|
| 19.1 |
Table 9: Overall Antibiotic Consumption in the
Latest Year by RHAs
RHA | HSE Area | Q1 | Q2 | Q3 | Q4 | Rate |
|---|
Area A | HSE Dublin & NE | 20.1 |
|
|
| 20.1 |
Area B | HSE Dublin & Midlands | 20.6 |
|
|
| 20.6 |
Area C | HSE Dublin & SE | 23.1 |
|
|
| 23.1 |
Area D | HSE SW | 22.6 |
|
|
| 22.6 |
Area E | HSE MW | 26.0 |
|
|
| 26.0 |
Area F | HSE W & NW | 22.4 |
|
|
| 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
