The changing patterns of antibiotics usage in Korea during 1981-2008

Background: The actual trends in antibiotic use in Korea are difficult to determine because antibiotic usage, which is not covered by insurance or not consumed in all hospitals in Korea, cannot be calculated accurately. Therefore, this study estimated the antibiotic usage indirectly from the data available in the 'Annual Products of Medicine,' which is published by the Korean Pharmaceutical Manufacturers Association. Materials and Methods: The data from 'Annual Products of Medicine in 2008' was analyzed. The cost and amounts of antibiotics produced were calculated and compared with previous data. Results: In 2008, the total cost of antibiotics was $ 1.6 billion, and the total amount was 1,140 tons. Since 1993, there has been an upward trend in the total amount of antibiotics produced. In contrast, there has been a downward trend in the proportion of antibiotics among all pharmacological agents produced. In terms of the amount, the production of cephalosporins was highest since 2003, whereas the production of penicillins was highest before 2003. The production of third and fourth generation cephalosporins is increasing, whereas that of first generation cephalosporins is decreasing gradually. Regarding the class of penicillins, the production of β-lactam/β-lactamase inhibitor combinations was the highest after 2003, whereas the production of aminopenicillin was the highest before 2003. Compared to 2003, although the amount of quinolones produced in 2008 has decreased by 52.9%, the cost increased by 41.7%. This was attributed to an increase in the production of ciprofloxacin and levofloxacin instead of older quinolones. Since 1993, aminoglycoside, tetracycline, lincosamide and chloramphenicol have been decreasing in both amount and cost. The increase in carbapenems (241.9%), antifungals (128.4%) and antiviral agents (193.2%) in 2008 is remarkable compared to that in 2003. Conclusions: The production and cost of broader spectrum and more expensive antibiotics are increasing, and is believed to be responsible for the emergence of resistance. Therefore, restriction of these broader spectrum antibiotics, such as carbapenems, is recommended.