Scientific Online Resource System

Annual for Hospital Pharmacy

Antibiotic Resistance And Monitoring Of Antibiotic Consumption In Hospital Settings

Michael M. Petrov


Introduction: Antibiotics are one of the key discoveries in human history. Unfortunately, the global rise in antimicrobial drug resistance has become one of the most pressing medical problems. Monitoring of antibiotic consumption is one of the most important components of all programs aimed at controlling the problem with the rising antimicrobial resistance.
Aim: The aim of this article is to present a free and internationally standardized electronic-based method for calculating the consumption of antibiotics in hospitals and in society.
Methodology: The system for classification of antibiotic agents ATC/DDD (Anatomical Therapeutic Chemi-cal/Defined Daily Dose), which is an international standard for calculation of antibiotic consumption in a univer-sal technical unit of measurement—defined daily dose, is used.
Practical Examples and Recommendations: The problem with the increasing antibiotic resistance was first discussed internationally at The Microbial Threat conference in Copenhagen in 1998. Monitoring antibiotic consumption is one of the key components of The European Community Strategy Against Antimicrobial Re-sistance from 2001. For the convenience of the users, open-source free software programs, incorporating the ATC/DDD system, such as ABC Calc and AMC Tool have been created for easy calculation of antimicrobial consumption.
Discussion: According to the latest ECDC report, total antibiotic consumption in EU countries has been decreasing since 2014, with data for 2020 showing that antimicrobial consumption has decreased further during the first year of the COVID-19 pandemic. The only exception is Bulgaria, where it has doubled.
Conclusion: ECDC data show that our country lags significantly behind other EU countries and immediate strict measures and actions are needed to combat the rising tide of antimicrobial resistance. Given the availabil-ity of free open-source programs for monitoring antimicrobial consumption, it would be very helpful to use them
more widely in Bulgarian hospitals, and hospital pharmacists should play a key role in this process.


antibiotics, antimicrobial resistance, antibiotic consumption

Full Text


Bloom DE, Cadarette D. Infectious Disease Threats in the Twenty-First Century: Strengthening the Global Response. Front Immunol. 2019;10:549. doi:10.3389/fimmu.2019.00549

Adedeji WA. The treasure called antibiotics. Ann Ib Postgrad Med. 2016;14(2):56-57.

World Health Organization (2014). Antimicrobial Resistance: Global Report on Surveillance [Online]. Available at: (Accessed: 23 June 2022).

Karakonstantis S, Kritsotakis EI, Gikas A. Pandrug-resistant Gram-negative bacteria: a systematic review of current epidemiology, prognosis and treatment options. J Antimicrob Chemother. 2020;75(2):271-282. doi:10.1093/jac/dkz401

Кирилов Б, Стоименова А, Григоров Е, Георгиев С, Петкова-Георгиева Е. Рационална употреба на лекарствата. Издател: ТЕА Дизайн ООД, ISBN 978-619-90647-9-5, София, 2019г., с.25.

Григоров Е, Белчева В, Салчев П. Място и роля на здравноикономическите и фармакоикономическите анализи за стабилността на здравната система. Здравна икономика и мениджмънт. 2014;14(3):3-10.

Infectious Diseases Society of America (2021). Drug-resistant Infections Led to $1.9 Billion in Health Care Costs, More Than 10,000 Deaths Among Older Adults in One Year [Online]. Available at:$1.9-billion-in-health-care-costs-more-than-10000-deaths-among-older-adults-in-one-year/ (Accessed: 23 June 2022).

Щерева-Тзуни Д, Насева Е. Същност и използване на икономически анализипри провеждане на научноизследователска разработка Обща медицина. 2020;22(5):100-104.

Reygaert WC. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482-501. doi:10.3934/microbiol.2018.3.482

Conclusions of the European Union Conference on ‚The microbial threat‘, 9-10 September 1998. The Copenhagen Recommendation. Ministry of Health Ministry of Food, Agriculture and Fisheries. Vet Res. 1999;30(1):119-122.

Frimodt-Møller N. Microbial Threat--The Copenhagen Recommendations initiative of the EU. J Vet Med B Infect Dis Vet Public Health. 2004;51(8-9):400-2. doi: 10.1111/j.1439-0450.2004.00786.x.

Bronzwaer S, Lönnroth A, Haigh R. The European Community strategy against antimicrobial resistance. Euro Surveill. 2004;9(1):30-4. doi: 10.2807/esm.09.01.00441-en.

Council of the European Union (2002). Council Recommendation of 15 November 2001 on the prudent use of antimicrobial agents in human medicine (Text with EEA relevance), Official Journal L 34, 13-16 [Online]. Available at: (Accessed: 23 June 2022).

European Union. European commission (2021). EU4Health programme 2021-2027 – a vision for a healthier European Union. [Online]. Available at: (Accessed: 23 June 2022).

Monnet DL. Measuring antimicrobial use: the way forward. Clin Infect Dis. 2007;44(5):671-673. doi:10.1086/511649

Grau S, Bou G, Fondevilla E, Nicolás J, Rodríguez-Maresca M, Martínez-Martínez L. How to measure and monitor antimicrobial consumption and resistance. Enferm Infecc Microbiol Clin. 2013;31 Suppl 4:16-24. doi:10.1016/S0213-005X(13)70128-9

World Health Organization (2022). WHO Collaborating Centre for Drug Statistics Methodology. Norwegian Institute of Public Health. [Online]. Available at: https://www.whocc. no/atc_ddd_index/ (Accessed: 23 June 2022).

Hutchinson JM, Patrick DM, Marra F, et al. Measurement of antibiotic consumption: A practical guide to the use of the Anatomical Therapeutic Chemical classification and Definied Daily Dose system methodology in Canada. Can J Infect Dis. 2004;15(1):29-35. doi:10.1155/2004/389092

European Society of Clinical Microbiology and Infectious Diseases (2022). ABC Calc (AMC Tool). [Online]. Available at: tool/ (Accessed: 23 June 2022).

Petrov M, Hadjieva N, Kantardjiev T, Velinov T, Bachvarova A. Surveillance of antimicrobial resistance in Bulgaria - a synopsis from BulSTAR 2003. Euro Surveill. 2005;10(6):7-8. doi:10.2807/esm.10.06.00548-en

Robertson J, Vlahović-Palčevski V, Iwamoto K, et al. Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications from ESAC-Net and WHO Europe [published correction appears in Front Pharmacol. 2021 Sep 30;12:765748]. Front Pharmacol. 2021;12:639207. Published 2021 Jun 17. doi:10.3389/fphar.2021.639207

Högberg LD, Vlahović-Palčevski V, Pereira C, et al. Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020. Euro Surveill. 2021;26(46):2101020. doi:10.2807/1560-7917.ES.2021.26.46.2101020

Веков Т, Митев М, Колев Ж. Болничната помощ в България през първото тримесечие на 2022 г. – икономически анализ на показателите в условията на затихваща COVID-19 пандемия. Медицински мениджмънт и здравна политика. 2022;53(1):3-13.



Article Tools
Email this article (Login required)