Trends in antimicrobial consumption: long-term impact of the COVID-19 pandemic.

Objectives: The COVID-19 pandemic was associated with a global decrease in antimicrobial consumption (AMC) in 2020. However, the persistence of this downwards trend is not known at a global level. This study examined the global and longer-term trends in AMC after the emergence of COVID-19.

Methods: The change rate of AMC was compared (a) 2020 over 2019, (b) 2021 over 2020, and (c) 2022 over 2021 using monthly sales volume data of antimicrobials in 69 countries obtained from the IQVIA MIDAS information service. Changepoints were detected using time-series data of global monthly antimicrobial sales from November 2016 to December 2023. We defined antimicrobials as oral and parenteral drugs classified as J1 by the Anatomical Therapeutic Chemical code. Antimicrobial sales were reported in standard units, as defined by IQVIA. We assessed the data using standard units per 1000 population per day, with populations based on World Population Prospects data issued by the United Nations. In addition, interrupted time-series analysis was used to examine the impact of movement restrictions in G7 countries.

Results: In the IQVIA MIDAS data, 68 of the 69 countries had more than one changepoint between 2016 and 2023. Of these 68 countries, 61 experienced a decrease in AMC after the COVID-19 pandemic started. However, 53 of these 61 countries showed a reverse increasing trend in AMC in 2022. Interrupted time-series analysis revealed that movement restrictions had a negative impact on AMC in all G7 countries.

Discussion: The global decrease in AMC in 2020 might not have been because of COVID-19 itself but to non-pharmaceutical interventions such as movement restrictions. Human mobility could possibly be one of the key determinants of antimicrobial use at the population level.