ArticlePloS one2021
High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed.
- Evolution of cefoperazone-sulbactam consumption in Romania between 2011 and 2024.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Veterinary fixed-dose antibiotics in Africa: a need for evidence-based regulation.Veterinary research · 2026Article
- Critical Analysis of Fixed-Dose Antibiotic Combinations Sold in Kinshasa-Democratic Republic of the Congo.Antibiotics (Basel, Switzerland) · 2026Article
- Infectious diseases, infection control, vaccines and long-term care: an European interdisciplinary Council on ageing consensus document.Aging clinical and experimental research · 2025Review
- Analysis of antibiotic use and access to drugs among poultry farmers in Kenya.One health (Amsterdam, Netherlands) · 2025Article
- The Political Economy of the World Health Organization Model Lists of Essential Medicines.The Milbank quarterly · 2025Article
- Strategic re-engineering of antibiotics.Nature reviews bioengineering · 2025Article
- Global trends in inappropriate use of antibiotics, 2000-2021: scoping review and prevalence estimates.BMJ public health · 2025Article
- Antibiotic consumption in 14 countries of sub-Saharan Africa: Findings from a retrospective analysis.PloS one · 2025Article
- Decreases and Pronounced Geographic Variability in Antibiotic Prescribing in Medicaid.Pharmacy (Basel, Switzerland) · 2024Article
- Prescribing Trends of Fixed-Dose Combination Antibiotics Not Recommended by the WHO (FNRs) for ICU Patients in Six Major Areas of China During a Seven-Year Period.Drug design, development and therapy · 2024Article
- Antibiotic appropriateness at outpatient settings in Ethiopia: the need for an antibiotic stewardship programme.Drugs in context · 2024Article
- Antimicrobial Sales Comparison before and after the Implementation of Nationwide Restriction Policy in Saudi Arabia.Antibiotics (Basel, Switzerland) · 2023Article
- Regulatory enforcement of the marketing of fixed-dose combinations in India: a case study of systemic antibiotics.Journal of pharmaceutical policy and practice · 2023Article
- RETRACTED: Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward.Antibiotics (Basel, Switzerland) · 2023Article
- Engineered live bacteria suppress Pseudomonas aeruginosa infection in mouse lung and dissolve endotracheal-tube biofilms.Nature biotechnology · 2023Article
- Observational
- Not recommended fixed-dose antibiotic combinations in low- and middle-income countries - the example of Tanzania.Antimicrobial resistance and infection control · 2023Review
- Article
- Systemic antibiotic sales and WHO recommendations, India.Bulletin of the World Health Organization · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Antibiotic fixed dose combinations (FDCs) can have clinical advantages such as improving effectiveness and adherence to therapy. However, high use of potentially inappropriate FDCs has been reported, with implications for antimicrobial resistance (AMR) and toxicity. We used a pharmaceutical database, IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS®), to estimate sales of antibiotic FDCs from 75 countries in 2015. Antibiotic consumption was estimated using standard units (SU), defined by IQVIA as a single tablet, capsule, ampoule, vial or 5ml oral suspension. For each FDC antibiotic, the approval status was assessed by either registration with the United States Food and Drug Administration (US FDA) or inclusion on the World Health Organization (WHO) Essential Medicines List (EML). A total of 119 antibiotic FDCs were identified, contributing 16.7 x 109 SU, equalling 22% of total antibiotic consumption in 2015. The most sold antibiotic FDCs were amoxicillin-clavulanic acid followed by trimethoprim/sulfamethoxazole and ampicillin/cloxacillin. The category with the highest consumption volume was aminopenicillin/β-lactamase inhibitor +/- other agents. The majority of antibiotic FDCs (92%; 110/119) were not approved by the US FDA. Of these, the most sold were ampicillin/cloxacillin, cefixime/ofloxacin and metronidazole/spiramycin. More than 80% (98/119) of FDC antibiotics were not compatible with the 2017 WHO EML. The countries with the highest numbers of FDC antibiotics were India (80/119), China (25/119) and Vietnam (19/119). There is high consumption of FDC antibiotics globally, particularly in middle-income countries. The majority of FDC antibiotic were not approved by either US FDA or WHO EML. International initiatives such as clear guidance from the WHO EML on which FDCs are not appropriate may help to regulate the manufacturing and sales of these antibiotics.
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