Trends in antimicrobial consumption in Bhutan

Highlights

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  Overall consumption of antimicrobials in Bhutan is lower than most other countries.

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  A notable increase in overall consumption of antimicrobials in Bhutan was observed from 2017 to 2019 .

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  Wide variation in antimicrobial consumption was observed between dzongkhags (administrative districts).

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  The penicillin group of beta-lactam antibiotics were most commonly consumed in Bhutan.

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  The increase in consumption of broad-spectrum antimicrobials in Bhutan is of concern.

Abstract

Introduction

Antimicrobial use has been recognized as one of the main drivers of antimicrobial resistanceand it is, therefore, crucial to monitor the consumption and use of antimicrobials. This study was conducted to determine the consumption of antimicrobials in terms of defined daily doses (DDDs) per 1000 inhabitants per day (DIDs) at both national and dzongkhag levels in Bhutan, and to investigate trends from 2017 to 2019.

Methods

A retrospective analysis of antimicrobial consumption in healthcare facilities in Bhutan from 2017 to 2019 was undertaken using the national records of annual distribution of medicines. World Health Organization Anatomical Therapeutic Chemical (ATC) Classification System/DDD methodology was used for data collection and analysis.

Results

In 2019, the consumption of antimicrobials (ATC subgroup J01) for systemic use in healthcare facilities in Bhutan was 16.29 DIDs, compared with 14.39 DIDs in 2018 and 13.27 DIDs in 2017. The most commonly used subgroup of antimicrobials was the penicillin group of beta-lactams (J01C).

Conclusion

Antimicrobial consumption in Bhutan was found to be lower than the European Union and European Economic Area average, and lower compared with most Eastern European countries and some countries in the Western Pacific region. However, overall consumption in Bhutan increased steadily over the 3-year study period. This should be monitored carefully, and appropriate interventions to optimize antimicrobial use should be put in place in the near future.