{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:40:33Z","timestamp":1790854833070,"version":"4.1.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0257424","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T13:27:54Z","timestamp":1631626074000},"page":"e0257424","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["A national survey of antibacterial consumption in Sri Lanka"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0184-104X","authenticated-orcid":true,"given":"Shalini","family":"Sri Ranganathan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandanie","family":"Wanigatunge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. P. S. G.","family":"Senadheera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. V. S. H.","family":"Beneragama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"issue":"12","key":"pone.0257424.ref001","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S1473-3099(13)70318-9","article-title":"Antibacterial resistance-the need for global solutions","volume":"13","author":"R Laxminarayan","year":"2013","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0257424.ref002","unstructured":"World Health Organization. Antimicrobial resistance: Global report on Surveillance 2014. Available at https:\/\/www.who.int\/drugresistance\/documents\/surveillancereport\/en\/, https:\/\/apps.who.int\/iris\/handle\/10665\/112642 Accessed 9th July 2021"},{"key":"pone.0257424.ref003","doi-asserted-by":"crossref","DOI":"10.15620\/cdc:82532","volume-title":"Antibacterial Resistance Threats in the United States, 2019","author":"Centers for Disease Control and Prevention","year":"2019"},{"issue":"4","key":"pone.0257424.ref004","first-page":"277","article-title":"\u201cThe antibacterial resistance crisis: part 1: causes and threats.\u201d","volume":"40","author":"CL Ventola","year":"2015","journal-title":"P & T: a peer-reviewed journal for formulary management"},{"key":"pone.0257424.ref005","volume-title":"Global Action Plan on Antimicrobial Resistance","author":"World Health Organization","year":"2015"},{"issue":"15","key":"pone.0257424.ref006","doi-asserted-by":"crossref","first-page":"E3463","DOI":"10.1073\/pnas.1717295115","article-title":"Global increase and geographic convergence in antibacterial consumption between 2000 and 2015","volume":"115","author":"EY Klein","year":"2018","journal-title":"Proceedings of the National Academy of Sciences"},{"issue":"9459","key":"pone.0257424.ref007","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0140-6736(05)17907-0","article-title":"Outpatient antibacterial use in Europe and association with resistance: a cross-national database study","volume":"365","author":"H Goossens","year":"2005","journal-title":"The Lancet"},{"key":"pone.0257424.ref008","first-page":"340","article-title":"Effect of antibacterial prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","author":"C Costelloe","year":"2010","journal-title":"BMJ"},{"key":"pone.0257424.ref009","volume-title":"World Health Organization model list of essential medicines, 21st List, 2019","year":"2019"},{"key":"pone.0257424.ref010","unstructured":"World Health Organization. WHO Report on surveillance of antibacterial consumption: 2016\u20132018 early implementation. 2018. Available at https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/277359\/9789241514880-eng.pdf?ua=1 Accessed 9th July 2021"},{"issue":"6","key":"pone.0257424.ref011","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/S2214-109X(18)30186-4","article-title":"Global-PPS network. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey","volume":"6","author":"A Versporten","year":"2018","journal-title":"Lancet Glob Health"},{"key":"pone.0257424.ref012","unstructured":"Surveillance and monitoring for antimicrobial use and resistance, IAGC discussion paper, June 2018. Available at https:\/\/www.who.int\/antimicrobial-resistance\/interagency-coordination-group\/IACG_Surveillance_and_Monitoring_for_AMU_and_AMR_110618.pdf Accessed on 9th July 2021"},{"key":"pone.0257424.ref013","volume-title":"WHO methodology for a global programme on surveillance of antimicrobial consumption","author":"World Health Organization","year":"2017"},{"key":"pone.0257424.ref014","unstructured":"The world bank in Sri Lanka -Overview. Available at: https:\/\/www.worldbank.org\/en\/country\/srilanka\/overview Accessed 9th July 201"},{"key":"pone.0257424.ref015","unstructured":"Annual Health Bulletin 2018, Ministry of Health, Sri Lanka. Available at http:\/\/www.health.gov.lk\/moh_final\/english\/public\/elfinder\/files\/publications\/AHB\/2020\/AHB_2017.pdf. Accessed 9th July 2021"},{"issue":"1","key":"pone.0257424.ref016","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4038\/sljid.v6i1.8105","article-title":"Analysis of urine culture isolates from seven laboratories of Sri Lanka: National Laboratory Based Surveillance of Sri Lanka College of Microbiologists in 2014","volume":"6","author":"S Jayatilleke","year":"2016","journal-title":"Sri Lankan Journal of Infectious Diseases"},{"issue":"1","key":"pone.0257424.ref017","first-page":"19","article-title":"Profile of extended spectrum \u03b2lactamase (ESBL) producing enterobacteria isolated from clinical specimens in a private teaching hospital in Sri Lanka","volume":"12","author":"V Perera","year":"2014","journal-title":"The Bulletin of the Sri Lanka College of Microbiologists"},{"key":"pone.0257424.ref018","first-page":"13","article-title":"Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibacterial susceptibility pattern\u2013A hospital based cross sectional study","volume":"17","author":"Luke WANV Fernando MMPSC","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0257424.ref019","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S1473-3099(20)30332-7","article-title":"Assessment of WHO antibacterial consumption and access targets in 76 countries, 2000\u201315: an analysis of pharmaceutical sales data","volume":"21","author":"EY Klein","year":"2021","journal-title":"The Lancet Infectious Diseases"},{"issue":"1","key":"pone.0257424.ref020","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4038\/pjsl.v10i1.57","article-title":"Antibacterial Consumption in the State Sector of Sri Lanka Over 25 Years: 1994\u20132018 Using the GAP Methodology","volume":"10","author":"BMR Fernandopulle","year":"2020","journal-title":"The Pharmaceutical Journal of Sri Lanka"},{"key":"pone.0257424.ref021","unstructured":"World Health organization, WHO Collaborating centre for drug statistics methodology. Available: https:\/\/www.whocc.no\/atc_ddd_index\/. Accessed 9th July 2021"},{"issue":"1","key":"pone.0257424.ref022","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4038\/pjsl.v9i1.49","article-title":"Antibacterial Medicine Consumption in Private and State Sector Outpatient Settings in Colombo District, Sri Lanka","volume":"9","author":"GPSG Senadheera","year":"2019","journal-title":"Pharmaceutical Journal of Sri Lanka"},{"issue":"6","key":"pone.0257424.ref023","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1136\/qshc.2006.021121","article-title":"European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibacterial use in Europe","volume":"16","author":"ESAC Project Group","year":"2007","journal-title":"Qual Saf Health Care"},{"issue":"1","key":"pone.0257424.ref024","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4038\/sljid.v6i1.8105","article-title":"Analysis of urine culture isolates from seven laboratories of Sri Lanka: National Laboratory Based Surveillance of Sri Lanka College of Microbiologists in 2014","volume":"6","author":"S Jayatilleke","year":"2016","journal-title":"Sri Lankan Journal of Infectious Diseases"},{"issue":"2","key":"pone.0257424.ref025","doi-asserted-by":"crossref","first-page":"56","DOI":"10.4038\/cmj.v58i2.5680","article-title":"A multi centre laboratory study of Gram negative bacterial blood stream infections in Sri Lanka","volume":"58","author":"P Chandrasiri","year":"2013","journal-title":"Ceylon Medical Journal"},{"key":"pone.0257424.ref026","volume-title":"Antimicrobial consumption","author":"European Centre for Disease Prevention and Control","year":"2018"},{"issue":"10","key":"pone.0257424.ref027","doi-asserted-by":"crossref","first-page":"e0204805","DOI":"10.1371\/journal.pone.0204805","article-title":"Community level antibacterial utilization in India and its comparison vis-\u00e0-vis European countries: Evidence from pharmaceutical sales data","volume":"13","author":"HH Farooqui","year":"2018","journal-title":"PLoS ONE"},{"issue":"11","key":"pone.0257424.ref028","doi-asserted-by":"crossref","first-page":"e1075","DOI":"10.1016\/S2214-109X(17)30365-0","article-title":"Access, Watch, and Reserve antibacterials in India: challenges for WHO stewardship","volume":"5","author":"P McGettigan","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"9","key":"pone.0257424.ref029","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.jiph.2020.04.010","article-title":"Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of blaKPC harboring Klebsiella pneumoniae","volume":"13","author":"WGM Kumuduni","year":"2020","journal-title":"Journal of Infection and Public Health"},{"key":"pone.0257424.ref030","first-page":"27","article-title":"Bacterial profile and antibacterial susceptibility pattern of adult lower respiratory tract infections in Colombo, Sri Lanka","volume":"1","author":"N Amarasinghe","year":"2018","journal-title":"Journal of Health and Social Sciences"},{"key":"pone.0257424.ref031","unstructured":"Empirical and prophylactic use of antimicrobials- National guidelines -2016. Available at https:\/\/slmicrobiology.lk\/antibacterial-guidelines-2016\/ Accessed 9th July 2021"},{"key":"pone.0257424.ref032","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s12879-021-05804-6","article-title":"Point-prevalence survey of outpatient antibacterial prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses","volume":"21","author":"HL Zhang","year":"2021","journal-title":"BMC Infect Dis"},{"key":"pone.0257424.ref033","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12875-017-0619-z","article-title":"Antibacterial overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians","volume":"18","author":"LG Tillekeratne","year":"2017","journal-title":"BMC Fam Pract"},{"key":"pone.0257424.ref034","unstructured":"National Medicines Regulatory Authority Act, No. 5 of 2015. Available at https:\/\/nmra.gov.lk\/images\/PDF\/gazzet\/PG\u20144687\u2014E.pdf. Accessed on 9th July 2021"},{"issue":"5","key":"pone.0257424.ref035","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.sapharm.2018.07.019","article-title":"Antibacterial dispensing practice in Sri Lankan community pharmacies: A simulated client study","volume":"15","author":"S Zawahira","year":"2019","journal-title":"Research in Social and Administrative Pharmacy"},{"key":"pone.0257424.ref036","doi-asserted-by":"crossref","first-page":"70","DOI":"10.4038\/cmj.v62i1.8439","article-title":"Practice of self-medication with antibacterials in the Colombo district, Sri Lanka","volume":"62","author":"GPSG Senadheera","year":"2017","journal-title":"Ceylon Medical Journal"},{"key":"pone.0257424.ref037","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s11908-013-0374-9","article-title":"Challenges in Measuring Antibacterial Consumption","volume":"15","author":"LAH Gravatt","year":"2013","journal-title":"Curr Infect Dis Rep"},{"key":"pone.0257424.ref038","volume-title":"GLASS Methodology for surveillance of national antimicrobial consumption","author":"World Health Organization","year":"2020"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257424","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T13:28:35Z","timestamp":1631626115000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257424"}},"subtitle":[],"editor":[{"given":"Muhammad Shahzad","family":"Aslam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,14]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0257424","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,14]]}}}