WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network AMC data 2014–2018 Abstract This report presents analyses of data on antimicrobial medicines consumption collected for the period 2014–2018 from non- European Union countries/areas in the WHO European Region. The analyses incorporate the substantial changes to defined daily doses introduced in January 2019 and revisions to the WHO Access, Watch and Reserve (AWaRe) classification in 2019. The report includes analyses of trends over time for key metrics of antibiotic consumption and considers new metrics to inform the responsible use of antibiotics. The WHO Regional Office for Europe and its partners remain committed to supporting countries/ areas in these endeavours through the activities of the WHO Europe Antimicrobial Medicines Consumption Network. Keywords ANTIMICROBIAL MEDICINES CONSUMPTION SURVEILLANCE NETWORKS ANTI-INFECTIVE AGENTS – THERAPEUTIC USE ANTIBIOTICS EPIDEMIOLOGICAL MONITORING DATA COLLECTION RESPONSIBLE USE OF ANTIBACTERIALS EASTERN EUROPE AND CENTRAL ASIA ISBN: 97-892-890-5556-7 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Officeor f Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network AMC data 2014–2018 Corrigenda WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network: AMC data, 2014-2018 ISBN: 97-892-890-5556-7 The following corrections were made in the electronic file on 5 July 2021: Page ii: ISBN ISBN has been modified. Initially published under ISBN: 97-892-890-5495-9 Page 1: 1.2 The WHO Europe AMC Network ‘One territory’ has been modified as ‘an area’. Page 2: 1.3 Previous publications of WHO Europe AMC Network data The last reference in the last paragraph has been modified with the correct year. Page 11: 2.6.6 Drug utilization 75% (DU75%) The reference in the fourth paragraph has been modified with the correct year. Page 21: Table 3.7 Volumes (percentages) of antibacterials at substance level (5th ATC group level) that compose DU75% (parenteral use) The last row of the table has been modified as ‘Total consumption of parenteral agents’. Table 64: 10.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) The last sentence of the third paragraph has been modified with the correct years. Page 159: 23 Discussion The reference in the first paragraph has been modified with the correct year. Page 164: References The first reference has been modified with the URL. Back cover: The ISBN barcode has been replaced. CONTENTS Acknowledgements vii Abbreviations viii Summary ix 1 Introduction 1 1.1 Background . 1 1.2 The WHO Europe AMC Network . 1 1.3 Previous publications of WHO Europe AMC Network data . 2 1.4 Scope and aim of this report . 2 2 Methods 3 2.1 Definition of consumption and use . 3 2.2 Data sources and data collection . 3 2.3 Anatomical Chemical Classification (ATC) and Defined Daily Dose (DDD) classification system . 5 2.4 Antibacterial agents included in this report . 6 2.5 Health sectors monitored . 7 2.6 Metrics and indicators reported . 7 2.7 Data interpretation . 14 3 Albania 16 3.1 Data source and years of data collection . 16 3.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 16 3.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 17 3.4 Consumption at substance level (5th ATC group level). 19 3.5 Other monitoring indicators . 21 3.6 Discussion. 21 4 Armenia 22 4.1 Data source and years of data collection . 22 4.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 22 4.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 23 4.4 Consumption at substance level (5th ATC group level). 25 4.5 Other monitoring indicators . 27 4.6 Discussion. 28 5 Azerbaijan 29 5.1 Data source and years of data collection . 29 5.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 29 5.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 30 5.4 Consumption at substance level (5th ATC group level). 32 5.5 Other monitoring indicators . 35 5.6 Discussion . 35 iii 6 Belarus 36 6.1 Data source and years of data collection . 36 6.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 36 6.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 37 6.4 Consumption at substance level (5th ATC group level). 39 6.5 Other monitoring indicators . 41 6.6 Discussion. 42 7 Bosnia and Herzegovina 43 7.1 Data source and years of data collection . 43 7.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 43 7.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 44 7.4 Consumption at substance level (5th ATC group level). 46 7.5 Other monitoring indicators . 48 7.6 Discussion. 49 8 Georgia 50 8.1 Data source and years of data collection . 50 8.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . 50 8.3 Relative consumption of Access, Watch and Reserve groups of antibiotics . 51 8.4 Consumption at substance level (5th ATC group level). 53 8.5 Other monitoring indicators . 56 8.6 Discussion. 56 9 Kazakhstan 57 9.1 Data source and years of data collection . 57 9.2 Estimates of volumes of consumption of antibacterials for systemic use (J01) . ..