National consumption of antimicrobials intended for use in animal livestock health: A longitudinal ecological analysis of antimicrobial imports to Uganda from 2018 to 2020.

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Abstract Background: Antimicrobial use in animals is one of the major drivers of the emergence and spread of resistant microorganisms. Antimicrobial resistance (AMR) can spread from animals to humans and vice versa. Monitoring antimicrobial consumption and use (AMCU) in the veterinary sector is important to identify areas of overuse and misuse and to design targeted interventions to reduce the need for and unintentional exposure. This study aimed to quantify and characterize by pharmacological class the antimicrobials intended for use in animals in different livestock production systems imported annually in Uganda. Methods: We abstracted data from the Uganda National Drug Authority database on all imported products intended for veterinary use from 2018 to 2020. We analysed the quantities of the active pharmaceutical ingredient using the World Organization for Animal Health (OIE) methodology and reported the consumption in kilograms and tonnes. Results: In total, 685.9 tonnes of antimicrobials for veterinary use were imported into Uganda from 2018 to 2020. Antibacterials accounted for 82% and antiprotozoals accounted for 18% of the total quantities over the three years. Oxytetracycline was the top most consumed antibacterial. The top five pharmacological classes were tetracyclines (225 tons, 44.8%), aminogylcosides + penicillin combination (153 tons, 29.7%), sulfonamides and trimethoprim (61.4 tons, 12.4%), macrolides (188 tons, 3.9%) and fluoroquinolones (167.6 tons, 3.5%). Ninety-seven percent of the antibacterials were from the WHO Veterinary Critically Important Antimicrobials, 57.1% were from the WHO Highly Important Antimicrobials group, 32.1% were from the Critically Important Antimicrobials group and 10.7% were from the Highest Priority group. The European Medicines Agency AMEG analysis revealed that 57.1% were from the lowest risk (D) category, 36.5% were from the intermediate risk (C) category and 6.5% were from the restricted use (B) category. Conclusion: This study provides baseline data on the national-level consumption of antimicrobials used in animal health in different livestock production systems in Uganda for future reference. Annual quantification and analysis of veterinary AMCU should continue to inform monitoring distribution and use in the framework of the One Health approach. Antimicrobial stewardship activities in the animal health sector should focus on restricting and ensuring appropriate use of CIA classes of macrolides, fluoroquinolones and polymixins to prevent dire consequences of crossover resistant organisms from animals to humans.

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