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Tracking global trends in the effectiveness of antibiotic therapy using the Drug Resistance Index
  1. Eili Y Klein1,2,
  2. Katie K Tseng3,
  3. Suraj Pant3,
  4. Ramanan Laxminarayan3
  1. 1Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, USA
  1. Correspondence to Dr Eili Y Klein; klein{at}


Background Evaluating trends in antibiotic resistance and communicating the results to a broad audience are important for dealing with this global threat. The Drug Resistance Index (DRI), which combines use and resistance into a single measure, was developed as an easy-to-understand measure of the effectiveness of antibiotic therapy. We demonstrate its utility in communicating differences in the effectiveness of antibiotic therapy across countries.

Methods We calculated the DRI for countries with data on antibiotic use and resistance for the disease-causing organisms considered by the WHO as priority pathogens: Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis. Additionally, we estimated pooled worldwide resistance rates for these pathogens.

Results 41 countries had the requisite data and were included in the study. Resistance and use rates were highly variable across countries, but A. baumannii resistance rates were uniformly higher, on average, than other organisms. High-income countries, particularly Sweden, Canada, Norway, Finland and Denmark, had the lowest DRIs; the countries with the highest DRIs, and therefore the lowest effectiveness of antibiotic therapy, were all low-income and middle-income countries.

Conclusions The DRI is a useful indicator of the problem of resistance. By combining data on antibiotic use with resistance, it captures a snapshot of how the antibiotics a country typically uses match their resistance profiles. This single measure of the effectiveness of antibiotic therapy provides a means of benchmarking against other countries and can, over time, indicate changes in drug effectiveness that can be easily communicated.

  • Antibiotic resistance
  • public health
  • low- and middle-income countries
  • antibiotic consumption
  • Onehealth

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  • Handling editor Alberto L Garcia-Basteiro

  • Contributors EK and SP conceived of and designed the study. EK, SP and KKT analysed the data and wrote the manuscript. RL provided critical revisions of the manuscript for important intellectual content. All authors read and approved the final version of this manuscript.

  • Funding EK and KKT were supported by grants from the Bill & Melinda Gates Foundation to the Global Antimicrobial Resistance Repository (OPP1112355) and the Global Antibiotic Resistance Partnership (OPP1135911) at the Center for Disease Dynamics, Economics & Policy. RL and SP were supported by Intergovernmental Personnel Agreements from the US Centers for Disease Control and Prevention (16IPA1609427 and 16IPA1609424). The funders had no role in the design of the study; data collection, analysis and interpretation; the writing of the report; or in the decision to submit the paper for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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