Evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024

The aim of this study is to describe the evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024. The use of this fixed-dose combination is not recommended by the World Health Organisation as it may result in selection of antimicrobial resistance.

This retrospective study analyzed the data on antibiotic consumption collected by the National Center for Surveillance and Control of Communicable Diseases which is based on data provided by the National Health Insurance Fund and the IQVIA-Multinational Integrated Data Analysis System. Antibiotic sales were converted into defined daily doses (DDDs) per 1,000 inhabitants per day.

The consumption of cefoperazone-sulbactam in Romania between 2011 and 2024 ranged from 0.016 to 0.021 DDD per 1000 inhabitants per day, with an average of 0.019 DDD per 1000 inhabitants per day. When adjusted for population, the RO1 macroregion registered the highest average consumption (0.033 DDDs per 1000 inhabitants per day). One-way ANOVA on DDD per 1,000 inhabitants per day data suggested that there were no statistically significant differences between macroregions (F = 2.78, p = 0.054). Although differences are observed in the mean values, they can be explained by counties with abnormally high consumption.

Educational and training activities focused on the outlier counties are necessary to raise awareness about the risk of increased selection of antimicrobial resistance. In line with the rejection of the reclassification proposal of cefoperazone-sulbactam in the updated 2025 WHO AWaRe classification of antibiotics, new government policies to ensure the discontinuation of cefoperazone-sulbactam use in Romania are needed.