Background All antibiotics were categorised into access, watch and reserve groups in the latest List of Essential Medicines by the WHO.¹ Antibiotics belonging to the reserve group should be protected and kept as a last resort when all others fail to give therapeutic effect.

Purpose To map the consumption of reserve class antibiotics during the past 5 years.

Material and methods The study was done on reserve group antibiotics which were selected based on the WHO definition. National data, regarding distribution to hospitals, were collected from wholesales statistics for the period between 2012 and 2016. Additionally, regional consumption data for 2016 were collected. Antibiotic use was analysed according to the Anatomical Therapeutic Chemical – Defined Daily Dose method (version 2017) and expressed in DDD per 100 patient-days.

Results During the study period an increase in the national use of reserve antibiotics from 0.13 to 0.26 DDD per 100 patient-days could be observed. This corresponds to a relative increase from 0.57% to 1.13% in the total use of antibiotics in the hospital. A noticeable increase in the use of colistine (from 0.09 to 0.19 DDD per 100 patient-days) and tigecycline (from 0.01 to 0.03 DDD per 100 patient-days) accounts for a great part of this upward trend. A huge variation in the regional use of reserve group antibiotics were also detected (mean: 0.26; min: 0.02; max: 1.08 DDD per 100 patient-days). Three out of four counties providing tertiary care were among the top consumers of these antibiotics.

Conclusion Though the collected data is a crude measure, it shows a trend in the increase (roughly doubled) in the absolute and relative use of reserve antibiotics nationally. This trend could be explained by several factors, as an increase in antibiotic resistance and increased access of these drugs. The detected large regional variations require further research. Since these antibiotics belong to the last-line treatment options, tight monitoring is essential, to maintain their therapeutic value.

Reference and/or Acknowledgements 1. WHO Model List of Essential Medicines, 20th List, World Health Organisation, 2017.

No conflict of interest