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For molecules not included in the ATC/DDD index, DDD values were estimated from other sources or as the average of DDD unit values by class ( SI Appendix , SI Methods ).

Data for SUs were available for all years, whereas kilogram data were available only for the period 2005–2015.

The ratio of SUs to kilograms for 2005–2015 was used to estimate kilograms and DDDs for

2000–2004

The explanatory variables included per capita gross domestic product (GDP; purchasing power parity); imports of goods and services as a percentage of GDP (as a measure of trade); measles vaccination coverage in children between the ages of 12 and 23 mo [lack of pneumococcal conjugate vaccination (PCV) coverage information limited our ability to include PCV coverage as a variable]; physician density per 1,000 population; and percentage of the population living in urban areas (as a measure of health system access).

All explanatory variables were pooled by country/year. Regression models analyzed data for HICs and LMICs separately.

Health and economic factors were obtained from the World Development Indicators in the World Bank DataBank (18).

Serial correlation was assessed using the Wooldridge test (19). Errors were clustered by country to account for high serial correlation. STATA version 14.1 was used for all statistical analyses. Global antibiotic consumption was calculated by extrapolating use for countries not included in the IQVIA database.

Extrapolations were based on the average per capita antibiotic use for countries from the same income group.

We then projected global antibiotic use until 2030, assuming constant per capita use rates for all countries at current levels, with total use increasing only through population growth. In addition to this baseline projection, we modeled two other scenarios: ( i ) no policy changes, where countries’ antibiotic consumption rates for 2016 through 2030 were assumed to continue to change based on their compounded growth rate between 2010 and 2015 and ( ii ) a target policy in which countries were assumed to converge to the 2015 global median antibiotic consumption rate by 2020 ( SI Appendix , SI Methods ).

Population projections were retrieved from the World Bank DataBank (18) except for Taiwan, for which data were obtained from the Taiwan National Development Council.

Global antibiotic consumption increased by 65% between 2000 and 2015, from 21.1 to 34.8 billion DDDs, while the antibiotic consumption rate increased 39% from 11.3 to 15.7 DDDs per 1,000 inhabitants per day over the study period.

The mean antibiotic consumption rate across countries increased 28% from 16.4 (SD 9.9) DDDs per 1,000 inhabitants per day to 20.9 (SD 9.8), and the median antibiotic consumption rate increased 25% from 15.5 to 19.5 DDDs per 1,000 inhabitants per day. The increase in global consumption was primarily driven by increased consumption in LMICs. In 2000, HICs, led by France, New Zealand, Spain, Hong Kong, and the United States, had the highest antibiotic consumption rates.

In 2015, four of the six countries with the highest consumption rates were LMICs (Turkey, Tunisia, Algeria, and Romania; Fig.

In HICs, although the total amount of antibiotics consumed increased 6% between 2000 and 2015, from 9.7 to 10.3 billion DDDs, the antibiotic consumption rate decreased by a modest 4%, from 26.8 to 25.7 DDDs per 1,000 inhabitants per day (Fig. In LMICs, antibiotic consumption increased 114%, from 11.4 to 24.5 billion DDDs, and the antibiotic consumption rate increased 77%, from 7.6 to 13.5 DDDs per 1,000 inhabitants per day. Low- and lower-middle-income countries (LMICs-LM) accounted for a greater share of this increase than upper-middle-income countries (LMICs-UM): total antibiotic consumption in LMICs-LM increased 117%, from 8.1 to 17.5 billion DDDs, while, in LMICs-UM, antibiotic consumption increased 110%, from 3.3 to 6.9 billion DDDs (Fig.

The antibiotic consumption rate in both LMICs-UM and LMICs-LM increased 78%, from 12.0 to 21.3 DDDs per 1,000 inhabitants per day, and from 6.7 to 11.9 amoxicillin 125mg 5ml for babies DDDs per 1,000 inhabitants per day, respectively. Download figure Open in new tab Download powerpoint.

Global antibiotic consumption by country: 2000–2015.

( A ) Change in the national antibiotic consumption rate between 2000 and 2015 in DDDs per 1,000 inhabitants per day.

For Vietnam, Bangladesh, The Netherlands, and Croatia, change was calculated from 2005, and for Algeria from 2002 as data before those years for those countries were not available.

( B ) Antibiotic consumption rate by country for 2015 in DDDs per 1,000 inhabitants per day.

All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas). Download figure Open in new tab Download powerpoint.

Global antibiotic consumption by country income classification: 2000–2015.

( A ) Graph showing how the antibiotic consumption rate in DDDs per 1,000 inhabitants

per

In B , each bar reflects total consumption in the specified year for that country or group of countries.

All rights reserved (https://www.iqvia.com/solutions/commercialization/geographies/midas). In 2015, the leading HIC consumers of antibiotics were the United States, France, and Italy, while the leading LMIC consumers were India, China, and Pakistan. Whereas antibiotic consumption in the three leading HICs marginally increased, the highest-consuming LMICs saw large increases. Between 2000 and 2015, antibiotic consumption increased from 3.2 to 6.5 billion DDDs (103%) in India, from 2.3 to 4.2 billion DDDs (

79%

Antibiotic consumption rate for HICs, LMICs-UM, and LMICs-LM of the four most-consumed therapeutic classes of antibiotics in DDDs per 1,000 inhabitants per day.

( A ) Broad-spectrum penicillins, which correspond to the Anatomical Therapeutic Chemical (ATC) classification of penicillins with extended spectrum (J01CA) excluding carbenicillins.