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Key message: Human consumption of antibiotics (antibacterials for systemic use, ATC J01) in the EU was largely at the same level in 2024 as compared to 2018. During the period, a temporary reduction was noted for the COVID-19 pandemic years of 2020 and 2021, after which consumption rebounded back to pre-pandemic levels. This highlights the need to strengthen efforts to address unnecessary and inappropriate human antibiotic use in the EU, in order to ensure an effective response to the emergence and spread of antimicrobial resistant bacteria.
Total consumption of antibacterials for systemic use (ATC J01), 2018-2024
The European Surveillance of Antimicrobial Consumption Network (ESAC-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC), is an EU/European Economic Area (EEA)-wide network of national surveillance systems providing reference data on antimicrobial consumption. Consumption of antibacterials for systemic use (anatomical therapeutic chemical (ATC) classification J01) is mainly monitored as defined daily doses (DDD) per 1000 inhabitants per day, from which the total annual consumption of the active antibiotic substance in tonnes can be estimated.
Human consumption of antibacterials for systemic use in the EU in all healthcare sectors combined (community, hospital, long-term care facilities) was largely at the same level in 2024 (20.3 DDD per 1000 inhabitants per day, 3091 tonnes of active substance) as compared to 2018 (20.2 DDD per 1000 inhabitants per day, 3212 tonnes of active substance). A temporary reduction was noted during the COVID-19 pandemic years of 2020 and 2021 (annual mean 16.5 DDD per 1000 inhabitants per day, 2591 tonnes of active substance), after which consumption rebounded back to pre-pandemic levels. The reduction during 2020 and 2021 was almost exclusively driven by changes in the community sector.
The 2023 Council Recommendations on stepping up EU actions to combat antimicrobial resistance in a One Health approach sets an EU target for reducing total consumption of antibiotics in humans, measured as DDD per 1000 inhabitants per day, by 20% between 2019 and 2030. As poor progress has been made so far, the EU is unlikely to meet this target by 2030 without considerable efforts.
Pharmaceutical legislation proposed under the Pharmaceutical Strategy for Europe aims to introduce measures to restrict and optimise the use of antimicrobial medicines. Combined with promoting more prudent use of antibiotics, targeting prescribers, pharmacists and patients as exemplified in the EU guidelines for the prudent use of antimicrobials in human health, these measures would help reduce antibacterial consumption in humans. Ensuring prudent use of antimicrobials is fundamental for an effective response to the emergence and spread of antimicrobial resistance, a public health concern causing more than 35,000 deaths annually in EU and EEA countries. It would also help reduce the use of substances that have toxic properties for the environment, such as sulfamethoxazole and trimethoprim found for example in antibiotics to treat urinary tract and ear infections.
Please consult the relevant indicators and signals below for a more comprehensive overview on the topic.
Antibiotic consumption reported through ESAC-Net refers to antimicrobials sold, dispensed or reimbursed within a setting, and does not reflect their actual use (e.g. ingestion, inhalation or injection) of antimicrobials. To ensure standardisation and comparability, ECDC ESAC-Net uses the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) index to classify antibiotic substances and monitor consumption in humans. The DDD represents the assumed average maintenance dose per day for a drug used for its main indication in adults.
Total consumption of antibacterials for systemic use (ATC J01), expressed as DDD per 1000 inhabitants per day has been selected as the primary indicator by the ECDC, the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA) to describe human antimicrobials consumption in the EU. A population-weighted EU mean of this indicator was selected by the Council for setting an EU reduction target of 20% between 2019 and 2030, to which progress is monitored by ECDC ESAC-Net on an annual basis. To ensure a robust methodology and to include all 27 EU Member States, missing data points for individual countries/years were imputed when needed, as further detailed in the ESAC-Net Annual Epidemiological Reports.
The annual total consumption of antibacterials for systemic use (ATC group J01) measured as tonnes of active antibacterial substance are included as an indicator representing the total environmental pressure derived from human antimicrobial consumption. This indicator is estimated by applying the weight allocations of individual antibiotic substances, as specified by the ATC/DDD index, to the related DDDs reported. As weight allocations are dependent on highly detailed data, no imputation for missing data were performed. To facilitate comparison over time, the number of countries included were restricted to the 23 EU countries reporting total care data for all years 2018-2024.
Relevant objectives under the Chemicals Strategy for Sustainability
Minimise exposure of humans and environment to substances hazardous to health and the environment, through risk management measures and full information to users of chemicals
Restore human health and environment to a good quality status
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