Skip to main content

Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016

International Journal of Clinical Pharmacy volume 43, pages 1065–1073 (2021)Cite this article

Abstract

Background Antibiotic resistance has reached an alarming rate globally especially in middle-income countries such as Lebanon. The development of antibiotic resistance is strongly linked to the increased population’s injudicious consumption of antibiotics. Objective This study aims to explore the trends of antibiotics consumption in the Lebanese community, between 2004 and 2016, to inform rational use of antibiotics. Setting The study was performed using the Intercontinental Marketing Statistics (IMS) Health Lebanon database Method This is an observational longitudinal study conducted through a review of the IMS database. The annual antibiotics consumption was determined by the Defined Daily Dose (DDD)/1000 inhabitants/day (DID). The trends of antibiotics consumption were then categorized by antibiotic class and spectrum of activity. Main outcome measure The total consumption of antibiotics in Lebanon and the classes of antibiotics used by the community. Results Total community consumption of antibiotics, measured by DDD/1000 inhabitants/day (DID), significantly increased from 18.71 in 2004 to 31.26 in 2016. Penicillin combinations, quinolones, third-generation cephalosporins, tetracyclines, and carbapenems showed significant uptrends, in contrast to first-generation cephalosporins, sulfonamides and diaminopyrimidines, and beta-lactamase resistant penicillins. Broad-spectrum antibiotics showed a marked increase in their consumption from 11.50 DID in 2004 to 22.51 DID in 2016 whereas intermediate-spectrum antibiotics had only a slight increase in their consumption from 7.18 DID in 2004 to 8.51 DID in 2016, and narrow-spectrum antibiotics had a severe decline in their consumption from 0.006 DID in 2004 to 0.0003 DID in 2016. Conclusion There is an alarming increase in antibiotics consumption in Lebanon, particularly broad-spectrum antibiotics. This should be complemented with evidence on the determinants of antibiotic consumption such as prescriber and patient-related factors and drug promotional activities to minimize antibiotics overuse.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Data availability

The data used in the study was obtained through Intercontinental Marketing Statistics (IMS Health Lebanon).

References

  1. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;14(1):13.

    Article  Google Scholar 

  2. Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742–50.

    Article  Google Scholar 

  3. Republic of Lebanon Ministry of Public Health. Statistical Bulletin 2014. 2014. Available from: https://www.moph.gov.lb/en/Pages/0/9947/statistical-bulletin-2014.

  4. Ammar W. The continuing challenges. In: Ministry of public health, editor. Health Beyond Politics. 1st ed. Wold Health Organization. 2009. pp. 1–18. Available from: https://www.moph.gov.lb/userfiles/files/Publications/HealthBeyondPolitics/Capter1-TheContinuingChallenges.pdf.

  5. World Bank. Lebanon | Data. Available from: https://data.worldbank.org/country/lebanon?view=chart.

  6. UNHCR. (3RP) Regional Refugee and Resilience Plan 2017–2018 in response to the Syria Crisis | 2017 Annual Report [EN/AR]—Syrian Arab Republic | ReliefWeb. 2018. Available from: https://reliefweb.int/report/syrian-arab-republic/3rp-regional-refugee-and-resilience-plan-2017-2018-response-syria-0.

  7. Araj GF, Avedissian AZ, Ayyash NS, Bey HA, El Asmar RG, Hammoud RZ, et al. A reflection on bacterial resistance to antimicrobial agents at a major tertiary care center in Lebanon over a decade. J Med Liban. 2012;60(3):125–35.

    PubMed  Google Scholar 

  8. Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, et al. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. Int J Infect Dis. 2016;46:64–70.

    CAS  Article  Google Scholar 

  9. World Health Organization. Regional Office for the Eastern Mediterranean. The work of WHO in the Eastern Mediterranean Region annual report of the regional director 2014. 2015. Available from: http://www.emro.who.int/annual_reports_2014/annual_report_2014.pdf.

  10. Tamma PD, Cosgrove SE. Antimicrobial Stewardship. Infect Dis Clin North Am. 2011;25(1):245–60.

    Article  Google Scholar 

  11. Nadeen Hilal, Racha Fadlallah CAS. K2P rapid response tackling the antibiotics resistance problem in Lebanon rapid response tackling the antibiotics resistance problem in Lebanon. 2015. Available from: https://www.aub.edu.lb/k2p/Documents/K2P Rapid response antibiotics 16 Nov 2015_EN.pdf.

  12. Plachouras D, Antoniadou A, Giannitsioti E, Galani L, Katsarolis I, Kavatha D, et al. Promoting prudent use of antibiotics: the experience from a multifaceted regional campaign in Greece. BMC Public Health. 2014;14(1):866.

    Article  Google Scholar 

  13. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y, et al. Significant reduction of antibiotic use in the community after a nationwide Campaign in France, 2002–2007 Klugman KP, editor. PLoS Med. 2009;6(6):e1000084.

    Article  Google Scholar 

  14. Philippe Dorosz, Claire Le Jeunne DVD. Guide pratique des médicaments Dorosz. 36th ed. Maloine, editor. USA: French and European Publications Inc; 2017. p. 1965.

  15. WHO Collaborating Centre for Drug Statistics Methodology. WHOCC - ATC/DDD Index ]. 2017. Available from: https://www.whocc.no/atc_ddd_index/.

  16. Cherri Z, González PA, Delgado RC. The Lebanese-Syrian crisis: impact of influx of Syrian refugees to an already weak state. Risk Manag Healthc Policy. 2016;14(9):165–72.

    Google Scholar 

  17. Republic of Lebanon Ministry of Public Health. Statistical bulletins 2018. 2018. Available from: https://www.moph.gov.lb/en/Pages/8/327/statistical-bulletins.

  18. United Nations High Commissioner for Refugees. Situation Syria regional refugee response. 2018. Available from: https://data2.unhcr.org/en/situations/syria.

  19. European Centre for Disease Prevention and Control. Summary of the latest data on antibiotic consumption in the European Union ESAC-Net surveillance data November 2017. Stockholm; 2017. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Final_2017_EAAD_ESAC-Net_Summary-edited - FINALwith erratum.pdf.

  20. Scicluna EA, Borg MA, Gür D, Rasslan O, Taher I, Redjeb SB, et al. Self-medication with antibiotics in the ambulatory care setting within the Euro-Mediterranean region; results from the ARMed project. J Infect Public Health. 2009;2(4):189–97.

    Article  Google Scholar 

  21. Cheaito L, Azizi S, Saleh N, Salameh P. Assessment of self-medication in population buying antibiotics in pharmacies: a pilot study from Beirut and its suburbs. Int J Public Health. 2014;59(2):319–27.

    Article  Google Scholar 

  22. Mouhieddine TH, Olleik Z, Itani MM, Kawtharani S, Nassar H, Hassoun R, et al. Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage. J Infect Public Health. 2015;8(1):20–31.

    Article  Google Scholar 

  23. Allouch A, Sabbah H, Hassan S, Sabbah S, Droubi N, Sabbah I. Antibiotic use, cost, and consumption in tertiary hospitals in lebanon: a comparative study before and after an implementation of antibiotic-restriction program (ARP). Br J Med Med Res. 2016;12(3):1–15.

    Article  Google Scholar 

  24. Saleh N, Awada S, Awwad R, Jibai S, Arfoul C, Zaiter L, et al. Evaluation of antibiotic prescription in the Lebanese community: a pilot study. Infect Ecol Epidemiol. 2015;5(1):27094.

    PubMed  Google Scholar 

  25. Bernier A, Ligier C, Guillemot D, Watier L. Did media attention of the 2009 A(H1N1) Influenza epidemic increase outpatient antibiotic use in France?: a time-series analysis. Viboud C, editor. PLoS ONE. 2013;8(7):e69075.

    CAS  Article  Google Scholar 

  26. Klein EY, Makowsky M, Orlando M, Hatna E, Braykov NP, Laxminarayan R. Influence of provider and urgent care density across different socioeconomic strata on outpatient antibiotic prescribing in the USA. J Antimicrob Chemother. 2014;70(5):1580–7.

    Article  Google Scholar 

  27. Laxminarayan R, Gelband H, Molly Miller P, Pant S, Gandra S, Levinson J, et al. The state of the world’s antibiotics, 2015 - center for disease dynamics, economics & policy (CDDEP). 2015. Available from: https://cddep.org/publications/state_worlds_antibiotics_2015/.

  28. Alsan M, Schoemaker L, Eggleston K, Kammili N, Kolli P, Bhattacharya J. Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis. Lancet Infect Dis. 2015;15(10):1203–10.

    Article  Google Scholar 

  29. World Health Organization. Worldwide country situation analysis: response to antimicrobial resistance. 2015. Available from: http://www.who.int/drugresistance/en/ISBN9789241564946.

  30. World Health Organization RO for the EM. Consultative meeting on antimicrobial resistance for countries in the Eastern Mediterranean Region: from policies to action Sharm el Sheikh, Egypt. 2013. Available from: https://apps.who.int/iris/bitstream/handle/10665/116211/IC_Meet_Rep_2014_EN_15210.pdf?sequence=1&isAllowed=y.

  31. Al-Faham Z, Habboub G, Takriti F. The sale of antibiotics without prescription in pharmacies in Damascus Syria. J Infect Dev Ctries. 2011;5(5):396–9.

    Article  Google Scholar 

  32. Sharara SL, Kanj SS. War and Infectious Diseases: Challenges of the Syrian Civil War. PLoS Pathog. 2014;10(11):e1004438.

    Article  Google Scholar 

  33. Bonten M. Infectious diseases in refugees coming from Syria and Iraq to Lebanon. Int J Infect Dis. 2014;21:1–460. https://doi.org/10.1016/j.ijid.2014.03.464.

    Article  Google Scholar 

  34. Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60(9):1308–16.

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank IMS Health Lebanon for providing us with the antibiotics consumption database.

Funding

This research did not receive any specific grant from funding agencies.

Author information

Affiliations

  1. CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon

    Nathalie Lahoud, Mira Hleyhel, Rouba Karen Zeidan, Patrick Maison & Nadine Saleh

  2. Institut National de Santé Publique, Epidémiologie Clinique Et Toxicologie, (INSPECT-LB), Beirut, Lebanon

    Nathalie Lahoud, Rana Rizk, Mira Hleyhel, Rouba Karen Zeidan & Nadine Saleh

  3. Faculty of Public Health, Lebanese University, Fanar, Lebanon

    Nathalie Lahoud, Mira Hleyhel, Maryo Baaklini, Rouba Karen Zeidan & Nadine Saleh

  4. Faculty of Pharmacy, Lebanese University, Hadat, Lebanon

    Nathalie Lahoud & Nadine Saleh

  5. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Kaslik, Lebanon

    Nahi Ajaka

  6. Centre Hospitalier Universitaire Notre Dame Des Secours, Jbeil, Lebanon

    Nahi Ajaka

  7. Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon

    Deema Rahme

  8. Université Paris Est, 7379, Créteil, EA, France

    Patrick Maison

  9. CHIC, Centre Hospitalier Intercommunal de Créteil, Créteil, France

    Patrick Maison

Authors
  1. Nathalie Lahoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rana Rizk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mira Hleyhel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maryo Baaklini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rouba Karen Zeidan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nahi Ajaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Deema Rahme
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Patrick Maison
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nadine Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deema Rahme.

Ethics declarations

Conflicts of interest

There was no conflict of interest to declare in this study.

Consent to participate

Not applicable for this study.

Consent for publication

Not applicable for this study.

Ethics approval

The study did not receive an IRB approval because the Lebanese University ethical committee waived the need for IRB approval for this study since it's an observational trend analysis of antibiotic consumption. The study neither involves contact with human beings nor includes any personal identifiers.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lahoud, N., Rizk, R., Hleyhel, M. et al. Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016. Int J Clin Pharm 43, 1065–1073 (2021). https://doi.org/10.1007/s11096-020-01218-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01218-7

Keywords

  • Antibacterial agents
  • Drug overuse
  • Drug resistance
  • Lebanon