Estimates of Antibacterial Consumption in Timor-Leste Using Distribution Data and Variation in Municipality Usage...

Area of Science:

• Global Health
• Pharmacology
• Infectious Diseases

Background:

• Antimicrobial resistance (AMR) and usage are significant global concerns.
• Lower-middle-income countries like Timor-Leste (TL) lack detailed antimicrobial usage data.
• Rising antimicrobial resistance rates are observed in TL human pathogens.

Purpose of the Study:

• To estimate national and sub-national antibiotic consumption in TL using distribution data.
• To stratify antibiotic consumption by resistance class and adherence to the national Essential Medicines List (EML) and WHO AWaRe guidelines.
• To provide data for understanding AMR and informing policy in TL.

Main Methods:

• Retrospective review of distribution data from Timor-Leste's central medical store (SAMES).
• Estimation of antibiotic consumption using defined daily dose (DDD)/1000 inhabitants/day methodology.
• Analysis stratified by municipality, EML adherence, and WHO AWaRe categories.

Main Results:

• National antibiotic distribution in TL's EML was estimated at 11.1 DDD/1000 inhabitants/day in 2019.
• Consumption rates are comparable to other lower-middle-income countries.
• Four of 13 municipalities exceeded the national average distribution.
• Approximately 32% of restricted antimicrobials were distributed incongruent with the EML.

Conclusions:

• This study provides crucial insights into previously poorly defined antimicrobial consumption in TL.
• Estimated consumption data can aid in understanding emerging resistance patterns.
• Findings support policy development, guideline enhancement, and antimicrobial stewardship activities in TL.