Antimicrobial Consumption and Utilisation in Zambia: Results from the Analysis of National Data for the Human and Animal Health Sectors.

Background/

Objectives

Antimicrobial Resistance (AMR) remains a growing public health threat, underscoring the need for robust surveillance of Antimicrobial Consumption (AMC) and Antimicrobial Use (AMU). This study analysed AMC and AMU trends in Zambia's human and animal health sectors, identifying priority areas for antimicrobial stewardship (AMS) under a One Health framework.

Methods

A retrospective study was conducted in February 2025, utilising data from 2018 to 2023. Sources of data included the Zambia Medicines Regulatory Authority (ZAMRA) and the WOAH Animal Antimicrobial Use (ANIMUSE) Global Database platform. AMC was analysed using the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) methodology. Antimicrobials were classified using the WHO Anatomical Therapeutic Chemical (ATC) system, and consumption was measured in Defined Daily Doses (DDDs) per 1000 inhabitants per day (DID). Antibiotics were further categorised using the WHO Access, Watch, and Reserve (AwaRe) classification. Data analysis was performed using IBM SPPS version 25.0.

Results

In the human health sector, oral antibiotics accounted for 88% of total consumption. Penicillins (33%), cephalosporins (19.2%), and macrolides (12.4%) were the most consumed classes. In 2023, 98,651,882.42 DDDs per 1000 inhabitants/day were recorded, with amoxicillin, ceftriaxone, and sulfamethoxazole/trimethoprim leading as the most consumed antibiotics. According to the consumption of antibiotics by the WHO AwaRe classification, 47% were Access, 40% Watch, and 3% Reserve group antibiotics. In animal health, tetracyclines dominated (63%), followed by sulphonamides (26%) and penicillins (11%). AMU in animal health peaked in 2023.

Conclusions

This study found high AMC and AMU, especially Watch-group antibiotics and tetracyclines, highlighting the need for strengthened antimicrobial stewardship, regulatory oversight, and integrated One Health surveillance to mitigate AMR risks in Zambia.