After decreased consumption during covid-19 pandemic, Denmark was in 2023 again using more antimicrobials. Particularly the youngest and oldest age groups were driving this trend according to the newest data from the DANMAP surveillance program.
In 2023, antimicrobial consumption for humans in Denmark was 6.6% higher than in 2022. Especially antimicrobials used to treat respiratory infections increased in 2023 due to high incidence of these infections, including RS viruses, influenza and Group A Streptococci.
“Even though it is of no surprise that the antimicrobial consumption in the community has increased after the low levels during the covid-19- pandemic, it is necessary to keep an eye on the development. It is important for medical doctors to keep in mind the principals for rational antimicrobial prescribing, namely to consider the necessity of treatment compared to the potential risk of development of antimicrobial resistance. The increased risk for development of antimicrobial resistance that comes along with increased consumption is rarely an issue for the current patient, who is treated, but it can over time develop to a public health issue” says Chief Physician Ute Wolff Sönksen from Reference Laboratory for Antibiotic Resistance Sönksen at Statens Serum Institute.
Increased antimicrobial consumption for children
The increase in antimicrobial consumption was most pronounced for children. Among the 0-4-year-olds the consumption increased by 30% from 2022 to 2023 (298 treated patients per 1,000 inhabitants in 2023 versus 229 treated patients per 1,000 inhabitants in 2022), and for the 5-9-year-olds, the increase was 60% (197 treated patients per 1,000 inhabitants in 2023 versus 122 treated patients per 1,000 inhabitants in 2022).
“Among children, the majority of antimicrobials are used to treat respiratory infections, but also skin wounds are treated with antimicrobials regularly. These infections spread in close contact with each other, as it is the case for children in kindergartens. Moreover, is seems that the decreased exposure to infections during lockdown, has resulted in a more susceptible population towards the infections that circulated after lifting the societal restrictions”, says Ute Wolff Sönksen.
Data from DANMAP 2023 also show that elderly inhabitants living at care homes received 90% more prescriptions than elderly inhabitants living in their own homes. The consumption was 1,819 prescriptions per 1,000 inhabitants at care homes compared to 957 prescriptions per 1,000 inhabitants in their own homes.
Urinary tract infections were the main reason for the observed difference in treatment frequency. However, antimicrobial consumption at care homes has altogether decreased by 28% from 2017 to 2023, whereas the decrease was 16% for elderly inhabitants living in their own homes.
Antimicrobials under threat
Shortages is an increasing problem in the supply of antimicrobials.
“One example is the unavailability of nitrofurantoin for urinary tract infections that lasted several months in 2023 due to a shortage. In the same period, consumption of other antimicrobials for urinary tract infections increased, as well as antimicrobials on special delivery. Special deliveries are allowed by Danish Medicines Agency in case of shortages but burden both the prescriber, the pharmacy and the agency with additional administrative work. Although a special delivery allows the doctor to prescribe a medicinal product that is not registered and marketed in Denmark, it is cumbersome and makes it difficult to keep track of the levels of demand and supply.”
“Supply issues affect all pharmaceutical products, and for antimicrobials there has been a worrisome increase in shortage cases as very few companies produce the active ingredients needed. This makes the supply of antimicrobials very vulnerable”, says Ute Wolff Sönksen.
Despite the observed increase in antimicrobial consumption from 2022 to 2023, the level is still 6.2% lower than in 2014. Since 2011, many initiatives were undertaken in order to reduce antimicrobial consumption in Denmark. Ute Wolff Sönksen expects that these initiatives will continue and bear fruit also in the future.
More surveillance results are published on www.danmap.org.
Statens Serum Institute will this year host an exciting debate about antibiotics during the antibiotic awareness week in November. Keep an eye out for the event, which will be announced on DANMAPs homepage in September.
