Assessing antimicrobial consumption in public and private sectors within the Costa Rican health system: current status and future directions

Abstract

Background Antimicrobial resistance is a significant global health threat. Therefore, robust surveillance systemsfor antimicrobial consumption (AMC) are essential to develop public health strategies. However, Latin Americancountries, including Costa Rica, face challenges in regularly reporting AMC data. This study aims to estimate andanalyse the overall AMC in Costa Rica for 2019.Methods This study is a national-level, retrospective, observational, and descriptive analysis of AMC in Costa Ricafrom 1 January to 31 December 2019. The study followed the World Health Organization (WHO) guidelines for theSurveillance of National AMC. The Anatomical Therapeutic Chemical (ATC) / Defined Daily Doses (DDD) system wasused to analyse types of antimicrobials and DDD per 1000 inhabitants per day (DID). Antimicrobial dispensation datafrom the Costa Rican Social Security Fund (CCSS) represented the public sector, while the private sector data wassourced from IQVIA. The analysis included data from both inpatient and outpatient sectors.Results A total AMC of 14.32 DID, of which 12.75 DID was within the public sector and 4.12 DID was within theprivate sector. Penicillins had the highest consumption nationally and in the public sector, while macrolides andlincosamides predominate in the private sector. According to the WHO-AWaRe (Access-Watch-Reserve) classification,antibiotics predominantly consumed nationally (74.7%) and in the public (83.0%) sectors are categorized underAccess, whereas the private (61.0%) sector predominates the Watch category.Conclusion This study illustrates the importance of enhancing AMC surveillance by integrating data from both thepublic and private sectors. The findings indicate an excessive use of “Watch” antimicrobials in the private sector. Toaddress this issue, all sectors and regulatory authorities must play an active and supportive role, in the developmentof effective, multisectoral policies. The methodology employed in this study is applicable to other Latin Americancountries, and therefore should be utilized for future analysis AMC in this region.