Changes in antibiotic consumption patterns after the implementation of the National Action Plan according to the AWaRe (Access, Watch, Reserve) classification system

The Korean government published the first National Action Plan (NAP) on AMR in August 2016, followed by a second plan in November 2021. The objective of this study was to analyze changes in antibiotic use patterns after implementation of the NAP in South Korea. We analyzed National Health Insurance (NHI) claims data for hospitals and clinics from January 2011 to December 2020. Consumption was measured using defined daily dose per 1,000 inhabitants per day (DID). We analyzed data for each year, dimension, and category of the AWaRe (Access, Watch, Reserve) classification system by the WHO. Monthly inpatient and outpatient antibiotic use was calculated, and an interrupted time-series (ITS) analysis to assess the trend in antibiotic use was conducted. The consumption of antibiotics increased from 25.78 DID in 2011 to 28.02 DID in 2016, then decreased in 2017 following the implementation of the NAP on AMR. The watch group showed a temporal decrease after implementation of the NAP; however, these figures increased until 2019, and the reserve group showed a downward trend beginning in 2017. According to the ITS analysis, the level (β ) and the slope of the trend (β ) of total antibiotic use decreased by 0.17 and 0.001, respectively. After implementation of the NAP, antibiotic use reduced from 7.18 DID in 2016 to 4.84 DID in 2017 for amoxicillin and beta-lactamase inhibitors, 0.81 DID to 0.7 DID for ciprofloxacin, and 0.81 DID to 0.65 DID for levofloxacin. After the implementation of the NAP in South Korea, antibiotic use in terms of total antibiotics and fluoroquinolone in the watch and reserve groups decreased. Further policies to improve the use of antibiotics in the watch and reserve groups are needed.