Decreasing Trends in Antibiotic Consumption in Public Hospitals from 2014 to 2017 Following the Decentralization of Drug Procurement in Myanmar

Abstract

(1) Background: In 2014, drug procurement for public hospitals in Myanmar was decentralized to a pull system. This might lead to increasing trends in the consumption of broad-spectrum and last-resort antibiotics. For fiscal years 2014-2017, we assessed annual antibiotic consumption trends and patterns in total defined daily doses (DDDs). (2) Methods: We followed World Health Organization (WHO) methodology for surveillance of antimicrobial consumption based on hospital antibiotic procurement records (as a proxy). (3) Results: In 32% of all public hospitals where data were retrieved, total antibiotic consumption reduced by 19% between 2014 (7,122,852 DDD) and 2017 (5,794,904 DDD). Consumption per 1000 inhabitants per day (<200 bed hospitals) also reduced from 0.6 to 0.3. Over 60% of procurement was for beta-lactam antibiotics and quinolones; quinolones decreased over time. Consumption of first-line antibiotics increased (42% in 2014 to 54% in 2017), whereas broad-spectrum antibiotics decreased (46% in 2014 to 38% in 2017). Linezolid was the only last-resort antibiotic procured. There was a progressive reduction in per capita government current health expenditure from approximately 9.2 US$ in 2014 to 8.3 US$ in 2017. (4) Conclusions: Antibiotic consumption decreased over time in public hospitals. This first study provides a baseline for developing an antibiotic consumption surveillance system in Myanmar.

Keywords

• operational research
• antimicrobial resistance
• antibiotic stewardship
• AWaRe
• SORT IT
• surveillance