Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study.

High antibiotic usage in adults is corroborated by health-care utilisation surveys done in LMICs that show a strong trend for adults to access community pharmacies as first point of contact and to self-medicate with over-the-counter antibiotics; 39 , 52 , 53 , 54 however, the prevalence of antibiotic usage in children might over-estimate that in adults due to the higher frequencies of paediatric respiratory infections and health-care visits. 37 Limited data on the sales and use of suboptimal (substandard or falsified) antibiotics exists and, therefore, has not been incorporated into our analysis. 55 , 56 The IQVIA MIDAS database is a proprietary database, restricting access and analysis.

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