Aim and scope

In compliance with the One Health concept, it is important to look at the use of antibiotics as a whole, i.e. the use of both human and veterinary antibiotics together. According to the AWaRe classification of antibiotics for human use and the AMEG categorisation of antibiotics for use in animals, antibiotics are divided into different categories based on their resistance risk and medical importance. The same ingredient may be classified in the lowest risk category for humans and the risk for public health in veterinary medicine is estimated higher. The aim is comparing the selection of antimicrobial ingredients in treatment of humans by AWaRe classification and in treatment of companion animals by AMEG categorisation. This analysis includes data of human and veterinary antibiotics in pharmaceutical form as tablets.

Results and conclusions

In 2020–2024, 36 different antimicrobial ingredients were used in human treatment and 28 in companion animal treatment, 7 of them for both: Amoxicillin, Amoxicillin/clavulanic acid, Cefadroxil, Cefalexin, Clindamycin, Doxycycline, Metronidazole. Both financially and quantitatively, the most sold antibiotic for humans and companion animals was Amoxicillin/clavulanic acid, classified for humans by AWaRe classification as “Access” (green, first-line) and for animals by AMEG classification as “Caution” (yellow, limited use) category. Amoxicillin/clavulanic acid accounted for 23% of the total cost of human antibiotics and for 64% of the total cost of antibiotics used in treatment of companion animals. The overall sales of AWaRe category “Access” antibiotics accounted for 78% of total human antibiotics, and the sales of AMEG category “Caution” antibiotics accounted for 90% of all antibiotics used for companion animals, in Estonia.

AWaRe and AMEG classifications are intended as tools for optimizing and monitoring antibiotic use, also for monitoring the impact of stewardship policies implemented to manage antimicrobial resistance.