Antibiotic consumption by Access, Watch and Reserve index in public sector of Limpopo province, South Africa: 2014–2018

Abstract

Background: The World Health Organization (WHO) classified antibiotics into three categories in 2017 – Access, Watch and Reserve (AWaRe) – intending to reduce the consumption of Watch and Reserve antibiotics while increasing the use of Access antibiotics. Antibiotic consumption by AWaRe in South Africa is undetermined because of data and research scarcity.

Objectives: The aim of this study was to quantify, describe and track antibiotic consumption between 2014 and 2018 in the public sector of the Limpopo province, South Africa, using the WHO’s AWaRe classification for 2021.

Method: Antibiotic consumption was quantified from pharmaceutical sales data for 2014–2018 by defined daily dose (DDD) per 1000 inhabitants per day (DID) and described according to the AWaRe classification. The change in antibiotic consumption was measured by compound annual growth rate (CAGR), Access-to-Watch index (AW-I), 75% drug utilisation index (DU75%) and amoxicillin index (AI).

Results: The absolute consumption of Access antibiotics decreased by a 4.0% CAGR from 3.7 DID in 2014 to 3.0 DID in 2018, with relative consumption remaining above 80.0%. Relative consumption of Watch antibiotics increased by 15.8% CAGR from 7.8% in 2014 to 19.7% by 2018. The AW-I decreased from 10.4 in 2015 to 4.1 in 2018. The AI increased from 17.8% in 2015 to 42.0% in 2018. Parenteral formulations’ DU75% comprised one Watch (ceftriaxone) and two Access (metronidazole and benzylpenicillin) antibiotics.

Conclusion: In Limpopo province’s public sector, the consumption of Watch antibiotics increased, while Access antibiotics consumption decreased, as reflected by both relative consumption and the decrease in the AW-I. The determinants of the Watch antibiotics increase require research attention.

Contribution: Our study addressed the paucity of surveillance and research data on antibiotic consumption in the Limpopo province, South Africa, according to the WHO AWaRe classification.