Μake us preferred on Google For decades, Greece has been characterized by high antibiotic consumption, a major driver of antimicrobial resistance with serious consequences for public health. The COVID-19 pandemic brought an unexpected — but ultimately temporary — reversal in the use of these drugs.
According to market data, antibiotic consumption fell significantly during the pandemic, only to begin a steady upward trajectory immediately afterward. By 2024, Greece had essentially returned to where it stood in 2018.
A second finding from the analysis of market data is even more concerning: “Access” antibiotics, which the World Health Organization (WHO) aims to account for at least 60% of total antibiotic consumption, remained below that threshold in Greece throughout the seven-year period studied.
The findings come from a new pharmacoepidemiological study of antibiotic use in Greece between 2018 and 2024, presented at the 6th Pharmacoepidemiology Symposium. The study was conducted by researchers Aristotelis Zarogoulidis, Panagiotis Zarogoulidis, Konstantinos Kassandros, Evangelia Nena, Theodoros Konstantinidis and Christos Kontogiorgis of Democritus University of Thrace.
The Sharp Drop and the Return
The researchers used monthly sales data from Greek community pharmacies, sourced from the IQVIA Hellas database. A total of 61 antibacterial active substances for systemic use were tracked over 84 consecutive months.
Consumption was calculated using the WHO’s internationally established ATC/DDD methodology and expressed as defined daily doses per 1,000 inhabitants per day, or DIDs.
According to the analysis, total consumption stood at 32.14 DIDs in 2018. In 2020, the first year of the pandemic, it fell to 26.48, while in 2021 it reached the lowest point of the entire period, at 24.65 DIDs.
Compared with 2018, this represented a decline of about 23% over three years.
According to the scientific community, this can be attributed to the spread of COVID-19, but more importantly to prolonged protective measures and lockdowns, which reduced the circulation of pathogens and led to a significant decline in infections caused by factors other than the coronavirus.
The picture, however, quickly reversed. In 2022, consumption rose to 28.61 DIDs, followed by 31.20 in 2023 and 31.77 DIDs in 2024.
In other words, almost the entire decline recorded during the pandemic was recovered within three years. By the end of the period, the difference between 2018 and 2024 had narrowed to just about 1.2%.
The researchers conclude that the decline during the COVID-19 period was temporary and that, by 2024, antibiotic use had returned close to pre-pandemic levels.
Which Antibiotics Are We Using?
The study does not focus only on the quantity of antibiotics consumed. It also examines the composition of that consumption, an especially important factor when addressing antimicrobial resistance.
In 2024, penicillins accounted for 36.1% of total antibiotic use in the community. They were followed by cephalosporins at 21.1% and macrolides at 20.8%.
The most frequently used active substance was the combination of amoxicillin and clavulanic acid. These are particularly popular antibiotics, which in previous years had also faced severe shortages, although those shortages have now been resolved.
Together, these three major therapeutic categories accounted for about eight in 10 daily doses consumed in 2024.
The more revealing finding, however, emerges when antibiotics are classified according to the WHO’s AWaRe system. The classification divides antibiotics, among other categories, into “Access” and “Watch” groups, based on their place in rational therapeutic use and their potential to contribute to antimicrobial resistance.
Below the WHO Target
According to the study, “Access” antibiotics remained below the WHO’s 60% target throughout the 2018-2024 period.
By contrast, “Watch” antibiotics accounted for the largest share of consumption.
The “Watch” category includes antibiotics that are more likely to contribute to the development of antimicrobial resistance. For this reason, the WHO says their use should be more closely monitored and restricted to cases in which they are genuinely indicated. The “Watch” category includes, among others, several cephalosporins, macrolides and fluoroquinolones.
“Access” antibiotics, by contrast, are those the WHO favors as first- or second-line treatment options for many common infections because they generally have a lower potential to drive resistance.
There is also a third major group, “Reserve” antibiotics, which are essentially backup drugs for serious infections caused by multidrug-resistant organisms.
The fact that “Access” antibiotics remain below 60% therefore carries particular significance. The total quantity of antibiotics being consumed is only one side of the problem. Which antibiotics are being used is equally critical.
The persistent dominance of “Watch” antibiotics is also why the researchers emphasize the need to strengthen policies promoting the rational use of antimicrobials.
The study begins with a finding that has challenged Greece’s healthcare system for years: the country is characterized by high antibiotic consumption and high levels of antimicrobial resistance.
The researchers set out specifically to determine how use in the community evolved, what happened during the pandemic and whether that dramatic change ultimately left a lasting mark.
An Opportunity That Did Not Last
According to the researchers, the data show that the pandemic was an unusual interlude.
Restrictions on social contact and major changes in the way society and healthcare operated coincided with a dramatic decline in antibiotic consumption.
The study, however, does not examine the individual reasons behind the decline and therefore cannot establish a causal relationship with specific factors.
What it can say clearly is what happened afterward: low consumption did not last.
The researchers’ message is therefore twofold. Antibiotic consumption in the Greek community remains high, while the continued dominance of “Watch” antibiotics indicates that the issue is not only how many antibiotics are being used, but also which ones are being selected.
The dramatic decline during the pandemic could have marked a change in course. The data from 2018 to 2024 show, however, that it was more of an interlude.
And within three years, that interlude had almost come to an end.
