Using oral and parenteral formulation of AWaRe antibiotics as a proxy estimate of primary healthcare and inpatient hospital sector use

SynopsisO_ST_ABSBackgroundC_ST_ABSBenchmarking antibiotic use across different healthcare sectors is crucial to improve use and implement the UNGA 70% Access target. Many countries only have available aggregate sales data, which do not have sector-specific usage information. The objective of this study is to estimate the proportion of oral antibiotic use across different healthcare sectors. Materials/methodsWe used IQVIA MIDAS(R) Quarterly Sales data and Global Point Prevalence Survey (Global-PPS) inpatient data from eight countries, including Belgium, Canada, China, Netherlands, Philippines, Saudi Arabia, Singapore, and United Kingdom, in 2019. Our analysis focused on Access and Watch antibiotics. In the main analysis, we assumed that all parenteral antibiotics were used exclusively in inpatient settings, an assumption we then relaxed through sensitivity analyses. The observed ratios of oral-to-parenteral antibiotics in the patient-level Global-PPS data were calculated, by dividing the volume of oral antibiotic use by that of parenteral antibiotic use, and then this calculated ratio was multiplied to the IQVIA MIDAS sales data to estimate oral antibiotic use outside of the inpatient sector. ResultsThe ratios of oral-to-parenteral use among inpatients in the Global-PPS data ranged between 0.05 (95%Credible Interval [CrI]: 0.03-0.09) and 1.01 (95%CrI: 0.56-1.80) in the main analysis. We estimated that overall, less than 7% of national oral antibiotics were used by inpatients, assuming exclusive parenteral use in inpatient settings in the main analysis, and less than 9% when assuming 90% of parenteral use was non-inpatient in the sensitivity analyses. ConclusionOur results suggest that where patient-level data are unavailable, alternative sources, such as antibiotic import data including routes of administration, can reasonably estimate sector-specific national use.