O0535 Impact of suggested defined daily dose (DDD) alterations on the calculated consumption of eight antibacterials for systemic use/route of administration for which clinical dosing differs widely from the current DDD, EU/EEA, 2016

Christelle ELIAS*1, Klaus Weist1, Vera Vlahović Palčevski2, Ole Heuer1, Dominique L. Monnet1

1European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden, 2University of Rijeka, Medical Faculty and University Hospital Rijeka, Rijeka, Croatia

Background: For several antibacterials for systemic use (ATC group J01), the defined daily dose (DDD) differs widely from the dose used in clinical practice. At a meeting convened by ECDC in cooperation with WHO, external experts found evidence justifying DDD alterations for eight antibacterials/routes of administration.

Aim: to examine the impact of suggested DDD alterations on consumption in EU/EEA.

Materials/methods: EU/EEA population-weighted mean total consumption (ATC J01) and consumption of the eight antibacterials/routes of administration (Table 1) were calculated in DDD/1000 inhabitants/day, applying the current and suggested DDD, for 29 EU/EEA countries that reported 2016 data to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net).

Results: EU/EEA population-weighted mean consumption of antibacterials (ATC J01) in the community in 2016 was 18.4 DDD/1000 inhabitants/day with the suggested DDDs; a decrease of 3.5 DDD/1000 inhabitants/day compared to the consumption currently reported by ESAC-Net. The reported EU/EEA hospital consumption would decrease from 2.1 to 1.8 DDD/1000 inhabitants/day. EU/EEA proportion of penicillins (ATC J01C) of total consumption (ATC J01) would decrease from 52 to 44% in the community and from 45 to 38% in hospitals. Table 1 presents the impact of the suggested DDD on EU/EEA population-weighted mean consumption of the eight antibacterials/routes.

Conclusions: Applying the suggested DDD resulted in lower consumption rates for EU/EEA, with the largest impact on penicillins, which nevertheless remained the most consumed group of antibacterials. Future studies should investigate how the suggested DDDs affect consumption trends, for EU/EEA and at national level.

Table 1. Impact of suggested DDD on EU/EEA population-weighted mean consumption of selected antibacterials, 2016

DDD(g) DDD/1000 inhabitants/day(range) Antibacterial-ATC Route code Suggeste Current Current DDD Suggested DDD  d

Ampicillin-J01CA01 Parenteral 2 6 0.05 (<0.01-0.68) 0.02 (<0.01–0.23) –0.03

Oral 1 1.5 5.22 (0.52-12.44) 3.48 (0.35–8.29) –1.74 Amoxicillin-J01CA04 Parenteral 1 3 0.08 (<0.01-0.17) 0.03 (<0.01-0.06) –0.05

Amoxicillin+enzyme Oral 1 1.5 5.38 (0.01-12.30) 3.59 (0.01-8.20) –1.79 inhibitor-J01CR02 – Cefepime-J01DE01 Parenteral 2 4.5 0.007 (<0.001-0.03) 0.003 (<0.001-0.01) 0.004

Meropenem-J01DH02 Parenteral 2 3 0.03 (<0.01-0.23) 0.02 (<0.01-0.15) –0.01

Ciprofloxacin-J01MA02 Parenteral 0.5 0.8 0.10 (<0.01-1.42) 0.06 (<0.01-0.89) –0.04

Colistin-J01XB01 Parenteral 3* 9* 0.02 (<0.01-0.11) 0.01 (<0.01-0.04) –0.01

* MU for colistin-J01XB01