A new analysis of pharmaceutical sales data from 67 countries indicates that antibiotic consumption has risen by more than 20% globally since 2016 but would likely have been much higher had the COVID-19 pandemic not occurred.

The study, published yesterday in the Proceedings of the National Academy of Sciences by researchers with One Health Trust, found that total antibiotic consumption for countries with available data rose 29.5 to 34.3 billion defined daily doses (DDD) from 2016 to 2023 (a 16.3% increase) and the overall consumption rate rose 10.6%. When the researchers extrapolated antibiotic use for countries that didn’t provide data, they estimated a 20.9% increase in total antibiotic consumption and 13.1% increase in the consumption rate.

The increase was lower than the 35.5% increase the researchers found when they looked at global antibiotic consumption during the previous 7-year period (2008 through 2015). But that’s because antibiotic consumption in the 67 countries with available pharmaceutical data, particularly the higher-income countries (HICs), saw significant declines in outpatient antibiotic use during the first year of the pandemic. Those declines have been attributed in part to masking, stay-at-home policies, and other SARS-CoV-2 reduction measures that may have reduced the transmission of respiratory pathogens that fuel outpatient antibiotic use.