Estimating global antibiotic needs for chronic obstructive pulmonary disease and community- and hospital-acquired pneumonia in 20 countries: A modelling analysis

Introduction: Antibiotic stewardship advocates for prudent antibiotic use. However, estimates of “appropriate” antibiotic use remain limited. Methods: We estimated the total antibiotics required to treat chronic obstructive pulmonary disease (COPD) exacerbations and pneumonia in 2019 across the 20 most populous countries. Antibiotic needs were determined according to World Health Organization AWaRe guidelines. The proportion of cases requiring antibiotics was based on bacterial etiology averages. Patients not responding to first-line treatment were assumed to either recover after second-line treatment, discontinue further care, or die during treatment. Where two treatment options were available, patients were assumed to be evenly split. Results: Penicillins (76.1%) and cephalosporins (22.6%) were the most frequently needed antibiotics for treatment of community-acquired pneumonia, followed by hospital-acquired pneumonia and COPD exacerbations. India and China were estimated as the greatest consumers of penicillins (37% and 21% of total use, respectively), followed by the US, Brazil, and Indonesia (15% combined). Per capita penicillin consumption was highest in India, Brazil, and Germany. In total, 2276,046 and 676,098 million mg of penicillins and cephalosporins, respectively, were needed. Conclusion: Prudent antibiotic use is essential to curb antimicrobial resistance. This framework offers a method for estimating needs and informing global planning.