The Major Factors Driving Global Antibiotic Consumption: A Quantitative Analysis of the Leading Determinants from 2000 to 2015

Abstract

Since the advent of antibiotics, bacteria have evolved through natural selection to become increasingly resistant to antimicrobial treatment. The human population now faces global antimicrobial resistance and an impending post-antibiotic era. This increase in resistant bacteria is, in large part, a consequence of improper or unnecessary consumption of antibiotics. By examining income, access to healthcare, strength of regulatory systems, sanitation, open defecation, education, age of the population, and nutrition, this thesis determines the major factors driving antibiotic consumption in both high-income and low- and middle-income countries. Additionally, this thesis examines each of these factors with respect to antibiotics by class, including 7 classes. Data on total antibiotic consumption and consumption by class was provided by the Center for Disease Dynamics, Economics & Policy, while most other variables were obtained from the World Development Indicators in the World Bank Databank. To analyze the data, I used principle component analysis biplots, variance inflation factors, and multiple linear regressions. In low- and middle-income countries, the use of basic sanitation facilities and the density of pharmaceutical personnel were found to have significant negative correlations to antibiotic consumption across classes. In high-income countries, the use of basic sanitation facilities, the density of pharmaceutical personnel, and primary school completion rates were found to have significant positive correlations to antibiotic consumption across classes. From an intervention perspective, this study emphasized the apparent need for improved sanitation levels and increased pharmaceutical personnel in low- and middle-income countries to reduce the spread of infection and promote optimization of treatment. Since low- and middle-income countries face a high burden infectious disease, access to certain antibiotics should increase, however, public policy efforts should aim to moderate inappropriate and substandard antibiotic use in order to reduce the global threat of antibiotic resistance.