Trends of ciprofloxacin use in Kazakhstan, impacts of COVID-19, and strategies for AMR control

The misuse of antibacterial agents is a key driver of the rapid and widespread rise in antimicrobial resistance (AMR). This study examines the consumption trends of ciprofloxacin-the second most consumed antibiotic in Kazakhstan across outpatient and inpatient settings-before, during, and after the COVID-19 pandemic to inform AMR mitigation strategies. The analysis is based on two data sources: a comprehensive review of national regulatory documents governing ciprofloxacin use and a pharmaco-epidemiological assessment of procurement data provided by Vi-ORTIS. Ciprofloxacin consumption (ATC group J01MA02) from 2017 to 2023 was quantified in DDD/1000 inhabitants/day (DID) via the ATC/DDD methodology. Only 16 of 50 recommendations in national protocols align with the ciprofloxacin prescribing guidelines established in international standards. During the pandemic, ciprofloxacin use increased, with total and outpatient consumption peaking in the third quarter of 2020, whereas inpatient consumption peaked earlier in the second quarter. In the post pandemic period, inpatient consumption steadily declined, reaching 0.06 DID in 2023. The persistent increase in the use of "Watch" antibiotics, including ciprofloxacin, has raised concerns for Kazakhstan's healthcare system. Strengthening antimicrobial stewardship programs, implementing targeted interventions, and enhancing surveillance efforts are essential to curbing antibiotic overuse and safeguarding public health.