Antimicrobial Use (AMU)
Antimicrobial use (AMU) refers to the consumption of antimicrobial agents - antibiotics, antifungals, antivirals, and antiparasitics - in human medicine, veterinary medicine, and agriculture. Monitoring AMU is essential for understanding and combating Antimicrobial Resistance (AMR).
Why AMU Surveillance Matters
Overuse and misuse of antimicrobials is the primary driver of AMR. Tracking consumption patterns helps:
- Identify areas of excessive or inappropriate use
- Guide antimicrobial stewardship programmes
- Evaluate the impact of policy interventions
- Compare usage patterns across countries and sectors
AMU Surveillance in Nordic Countries
Human AMU
AMU in humans is tracked through prescription databases and pharmaceutical sales data:
| Country | Key Data Sources | Responsible Entity |
|---|---|---|
| Denmark | Register of Medicinal Product Statistics | SSI, DHDA |
| Finland | Finnish Prescription Register (FPR) | Fimea |
| Iceland | Medicines prescription database | Directorate of Health |
| Norway | Norwegian Prescription Database | NIPH |
| Sweden | Pharmaceutical sales statistics database | Swedish eHealth Agency, PHAS |
All Nordic countries use the ATC classification system (Anatomical Therapeutic Chemical) and measure consumption in Defined Daily Doses (DDDs), as recommended by the WHO Collaborating Center for Drug Statistics Methodology at NIPH.
Veterinary AMU
Veterinary AMU monitoring covers antimicrobial sales to farms, prescriptions, and usage in food-producing animals:
| Country | Key Data Sources | Responsible Entity |
|---|---|---|
| Denmark | VetStat national database | DVFA, DTU Food |
| Finland | Wholesaler sales data | Fimea, Ruokavirasto |
| Iceland | Sales data + Heilsa veterinary database | MAST |
| Norway | Veterinary Prescription Register (VetReg) | NFSA, NIPH |
| Sweden | Pharmaceutical sales statistics | SVA, SBA |
Denmark's VetStat
Denmark’s VetStat is considered one of the most detailed and comprehensive systems for monitoring veterinary drug use worldwide. It gathers data from veterinarians, pharmacies, and feed mills, including information on animal species, age groups, and diagnostic indications.
Reporting Standards
AMU data from Nordic countries is reported to:
- ESAC-Net - European Surveillance of Antimicrobial Consumption Network
- ESVAC / ESUAvet - European Sales and Use of Antimicrobials for Veterinary Medicine (renamed ESUAvet from 2023)
Legal Frameworks
AMU surveillance is grounded in national legislation:
- Denmark: Act on Medicines (Lov om lægemidler)
- Finland: Communicable Diseases Act (1227/2016), Medicines Act (395/1987)
- Iceland: Act on Health Security and Communicable Diseases (No. 19/1997)
- Norway: Medicines Act (1992), Communicable Diseases Control Act (1994)
- Sweden: Communicable Disease Act (2004:168), Feed Act (1985:295)
All countries also align with EU Regulation (EU) 2019/6 on veterinary medicinal products.
Relationship to AMR
AMU and AMR are two sides of the same coin. The One Health approach requires monitoring both to understand how antimicrobial consumption in humans, animals, and the environment drives resistance. Each Nordic surveillance programme integrates AMR and AMU data:
- DANMAP - integrates human and animal AMR + AMU
- FINRES-Vet - separate human and veterinary reports
- NORM-Vet - joint annual report
- Swedres-Svarm - combined human and veterinary report