Antimicrobial resistance

Surveillance of antimicrobial use

Surveillance of antimicrobial use tracks how and why antimicrobials are being used and misused by patients and healthcare providers. Monitoring antimicrobial prescription and consumption behavior provides insights and tools needed to inform therapy decisions, to assess the public health consequences of antimicrobial misuse, and to evaluate the impact resistance containment interventions.

As an advocacy resource at local or national level, the European Surveillance of Antimicrobial Consumption programme (ESAC) has demonstrated that monitoring antimicrobial use patterns and costs can prove the crucial factor driving political commitment to successful campaigns to contain resistance, especially when surveillance of use is enhanced by surveillance of resistance.

Tracking antimicrobial consumption and use behavior

Tracking consumption statistics quantifies the selection pressure on microbial populations and permits benchmarking comparisons at country or healthcare facility level and evaluation of the impact of educational or regulatory interventions. A common way to express consumption totals is through the use of “Defined-Daily Doses” or DDDs, maintained by the WHO Collaborating Centre for Drug Statistics Methodology in Oslo.

For insights into how antimicrobials are used, indicator studies and focused surveys of patients, prescribers, and dispensers are used to explore the factors which drive antimicrobial use decisions. Examples of indicators include the following.

  • Average number of medicines prescribed per patient counter.
  • Percentage of encounters with an antibiotic prescribed.
  • Percentage of cases of malaria treated with recommended antibiotics.
  • Percentage of cases of diarrhoea treated with oral rehydration therapy.
  • Percentage of patients receiving medicines without prescription.

WHO Guidelines for surveillance of antimicrobial use

Health clinics and hospitals
Surveillance of antimicrobial use