Specificity of antimicrobial consumption in Bosnia and Herzegovina

Abstract

Presentation of continuous monitoring of antimicrobial drug consumption, since consumption is associated with antimicrobial resistance. Data are collected and processed to be valid, representative and comparable to data on antimicrobial drug consumption in other countries. Valid 2010-2020 total antimicrobial use data of Bosnia and Herzegovina were analysed according to the WHO Anatomical Therapeutic Chemical (ATC)/Defined Daily Doses (DDD) methodology and expressed in DDD/1000 inhabitants/day (DID). Consumption was also analyzed using the WHO AWaRe (Access, Watch, Reserve) classification. Total antibacterial consumption was 18.1 DID in 2010, and 19.2 DID in 2020. The top 5 antibacterial subgroups (ATC level 3) in 2020 were: penicillins, ATC group J01C (5.8 DID, 30.2% of all antibacterials); macrolides, lincosamides, streptogramins, J01F (4.5 DID, 23.4%); other beta-lactam antibacterials, J01D (3.2 DID, 16.7%); quinolones, J01M (2.5 DID, 13%); tetracyclines, J01A (1.3 DID, 6,8%) and sulfonamides and trimethoprim, J01E (1.3 DID, 6.8%). The top 5 antibacterials (ATC level 5) in 2020 were: azithromycin (3.36 DID), amoxicillin and enzyme inhibitor (co-amoxiclav, 2.56 DID), amoxicillin (2.29 DID); ciprofloxacin (1.9 DID); sulfomethoxazole and trimethoprim (1.29 DID). During the monitoring of consumption using the AWaRe classification in the period 2015-2020. year, the relative consumption of antibiotics from the Access group is over 60%. Standardised and validated data set of antimicrobial use suggests good antibiotic prescribing practise (would have met the WHO target of at least 60% of total consumption being Access agents, according to the WHO AWaRe classification) but also offers opportunities for quality improvement (appropriate use of co-amoxiclav, azithromycin and ciprofloxacin).