Essential medicines and health products

Surveillance of Antimicrobial Use

Surveillance of antimicrobial use tracks how and why antimicrobials are being used by patients and healthcare providers. Monitoring antimicrobial prescription and consumption behaviour provides insights and tools needed to inform therapy decisions, to assess the public health consequences of antimicrobial misuse, and to evaluate the impact of resistance containment interventions.

As an advocacy resource at local or national level, the European Surveillance of Antimicrobial Consumption network (ESAC-Net) has demonstrated that monitoring antimicrobial use patterns and costs can prove the crucial factor driving political commitment to successful campaigns to contain resistance, especially when surveillance of use is enhanced by surveillance of resistance.

Measuring antimicrobial consumption and use

Antimicrobial consumption statistics quantify the ecological selection pressure on microbial populations. Antimicrobial consumption often translates as sales of antimicrobial medicines. It permits benchmarking comparisons at global, country or healthcare facility level and evaluation of the impact of educational or regulatory interventions. A common way to express consumption totals is through the use of “Defined-Daily Doses” or DDDs, maintained by the WHO Collaborating Centre for Drug Statistics Methodology in Oslo, Norway.

For insights into how antimicrobials are used, indicator studies and focused surveys of patients, prescribers, and dispensers are used to explore the factors that drive antimicrobial use decisions. Examples of indicators include the following.

  • Average number of medicines prescribed per patient counter
  • Percentage of encounters with an antibiotic prescribed
  • Percentage of cases of malaria treated with recommended antibiotics
  • Percentage of cases of diarrhoea treated with oral rehydration therapy
  • Percentage of patients receiving medicines without prescription

WHO Guidelines for Surveillance of Antimicrobial Use

Surveillance of antimicrobial consumption

Other WHO resources on use of medicines


Health Clinics and Hospitals


AGISAR Guidance on integrated surveillance of antimicrobial resistance

WHO Reports on surveillance of antimicrobial use

WHO Reports on surveillance of use of medicines


New method developed to measure antimicrobial consumption to help countries address resistance