'Global Trends in Antibiotic Consumption, 2000-2010', a study by scientists from Princeton University, has found that worldwide antibiotic use has risen by 36% over those 10 years, with five countries — Brazil, Russia, India, China and South Africa (BRICS) — responsible for more than three-quarters of that surge. Among the 16 groups of antibiotics studied, cephalosporins, broad-spectrum penicillins and fluoroquinolones accounted for more than half of that increase, with consumption rising 55% from 2000 to 2010.
During this period, India's antibiotic use went up from eight billion units (2001) to 12.9 billion units (2010).
The study quantifies the growing alarm surrounding antibiotic-resistant pathogens and a loss of efficacy among antibiotics used to combat the most common illnesses. It confirms an increasing resistance to carbapenems and polymixins, two classes of drugs long considered the last resort antibiotics for illnesses without any other known treatment.
"Indians consume around 11 antibiotic tablets per year," Ramanan Laxminarayan, one of the authors of the study, told TOI. "That's five days of antibiotics for every person in the country, which is more than the Chinese or Brazilians. An average Chinese popped seven antibiotic pills a year. However, both India and China's numbers are lesser than the Americans who on average pop 22 antibiotic pills a year. The paper confirms that global use of antibiotics is surging and specially in India."
Laxminarayan said that was both good news and bad news. "It means that more Indians are able to access antibiotics, which are particularly important for those who previously died of easily treatable infections," he said. "However, the massive increase in use, both appropriate and inappropriate, is leading to increases in drug resistance. Antibiotic use is the single most important reason for resistance. Also use of last resort drugs like carbapenems has gone up significantly in India, and it is difficult to justify why such powerful antibiotics are being use so much more frequently."
Laxminarayan said it had to be remembered that before we had antibiotics, it was pretty easy to die of a bacterial infection. "And we're choosing to go back into a world where you won't necessarily get better from a bacterial infection," he said. "It's not happening at a mass scale, but we're starting to see the beginning of when the antibiotics are not working as well."
Professor Dame Sally Davies, chief medical officer for England and chief scientific adviser for the Department of Health, London, said: "This paper breaks new ground with the comparative antibiotic consumption data by country of the first decade of the 21st century. There is a direct relationship between consumption and development of antibiotic resistance, so the data is key for us all developing a 'National Action Plans Against Antimicrobial Resistance' as set out in the World Health Assembly Resolution in May."
The study noted that the use of antibiotics tended to peak at different times of the year, corresponding in almost every case with the onset of the flu season. In the northern hemisphere, for example, consumption peaked between January and March, while in the southern hemisphere it peaked between July and November. One notable exception was India, for which usage peaked between July and September, correlating with the end of the monsoon season.