Antibiotic consumption in 19 health care facilities in Southeastern Gabon (2016-2018): a pilot study using World Health Organization-defined daily doses and AWaRe classification

Inappropriate use of antibiotics is a major driver of antimicrobial resistance, especially in low- and middle-income countries where surveillance data remain scarce. This pilot study aimed to evaluate antibiotic consumption in 19 health care facilities in southeastern Gabon from 2016-2018, using the World Health Organization's defined daily doses (DDD) and AWaRe (Access, Watch, and Reserve) classification frameworks.

This retrospective, descriptive study is based on data extracted from drug stock registers. Antibiotic consumption was measured in DDD and defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day or DID). Systemic antibiotics were categorized using the World Health Organization's AWaRe classification.

A total of 557,361 DDDs were recorded over the 3-year period. Antibiotics in the Watch category accounted for the majority of consumption (69.2%), followed by those in the Access category (29.5%). The overall annual DID (DDD/1000 inhabitants/day) declined significantly from 2.2 in 2016 to 0.13 in 2018, with the most notable reduction observed in Access-category antibiotics. The most commonly used antibiotics included doxycycline, gentamicin, and cotrimoxazole. Gentamicin was the most frequently used antibiotic across all facility types, representing over 50% of total DDDs in dispensaries, health centers, medical centers, and regional hospitals. AWaRe category distribution varied by facility level. Access-category antibiotics predominated in dispensaries and medical centers (83.4%), whereas Watch-category antibiotics were more prevalent in health centers (75.5%) and regional hospitals (78.6%).

This study provides foundational data on antibiotic consumption in southeastern Gabon, a region where such information was scarce. The high prevalence of Watch-category antibiotic use highlights the urgent need for enhanced regulation and targeted antimicrobial stewardship strategies to ensure appropriate use and curb the spread of antimicrobial resistance.