A: Antibiotic Footprint is a tool to measure and understand the total magnitude of antibiotic use. Using a holistic approach, Antibiotic Footprint seeks to measure the total amount of antibiotics used in all human activities, including direct antibiotics consumption at the community and hospital levels, and indirect consumption in agricultural production.

A: The Antibiotic Footprint is necessary because many people are unaware of the problems arising from the misuse and overuse of antibiotics in humans and animals. We believe that the more people understand how much antibiotics humans and animals consume, the more likely they are to understand these problems and reduce their antibiotic use. This would have a beneficial global impact, and ultimately lead to fewer people dying from antimicrobial resistance (AMR).

A: The misuse and overuse of antibiotics is the major driver of the growing problem of antimicrobial resistance (AMR), an important cause of death worldwide. It is important to note that both appropriate use and misuse of antibiotics can increase the spread of AMR. Commonly used terms like ‘the war against superbugs’ or ‘the fight against AMR’ often lead people to request ‘stronger’ antibiotics or to focus on residual bacteria in meat, while ignoring the misuse and overuse of antibiotics. We hope that Antibiotic Footprint could be an awareness raising tool that catalyses people to reduce their Antibiotic Footprint to a minimum.

A: Antibiotic Footprint includes antibiotic use in agriculture because most of the antibiotics fed to animals are excreted un-metabolized, then enter sewage systems and water sources, thereby fostering antibiotic-resistant bacteria in the environment (AMR review, 2015). We can reduce the spread of antimicrobial resistance by reducing the antibiotic use in agriculture. Therefore, antibiotic use in agriculture is included in the Antibiotic Footprint.

A: A country’s Antibiotic Footprint is the total amount of antibiotics consumed in that country. We estimate this by combining the total amount of antibiotics consumed by humans and by animal agriculture.

We do this because most of the antibiotics fed to animals are excreted un-metabolized and then enter sewage systems and water sources, thereby fostering antibiotic-resistant bacteria in the local environment. We believe that knowing the total magnitude of antibiotic used in both human and animals in the country will have the impact to the people in the country.

While it is true that antibiotic use in animal agriculture could increase or decrease depended on the total amount of livestock, it is also true that countries that only import meat and do not raise any animals will not have antibiotics excreted from animals into the environment. Therefore, to provide the information holistically, we present antibiotic use data from all sectors per country and per human capita.

A: There is considerable similarity between the concept of ‘carbon footprint’ and that of Antibiotic Footprint. While we need to use some level of energy to survive, using too much energy has been driving climate change globally. Similarly, while we need antibiotics if we are infected with bacteria, the overuse and misuse of antibiotics have driven more and more bacteria to become ‘superbugs’ – bacteria that are resistant to multiple antibiotics. Without global action to reduce antibiotic usage, more and more people will die of these superbugs.

A: You are wrong. Antibiotics work on bacteria – hence their name. They do not work on common cold viruses. Antibiotics are not needed for most people with a common cold or an acute sore throat. Acute sore throat is self-limiting and usually triggered by a viral infection.

If you live in a developed country, please follow your doctor’s advice and do not use antibiotics to treat an acute sore throat. If you live in a developing country and can buy antibiotics over-the-counter, please note that antibiotics are not needed for acute sore throat or the common old. Please go to see a doctor if you think that your sore throat has a sign of serious illness and think that you may need antibiotics. Reducing the overuse and misuse of antibiotics for the common cold is one of the best ways to reduce your own Antibiotic Footprint.

A : Currently, indicators used for antibiotic consumption in human and animals include defined daily dosage (DDD) per 1,000 inhabitants per day and milligrams per population correction unit (PCU). Originally created to provide fair comparisons among different antibiotics and different animals, these terms are commonly used by researchers and policy makers. Details of antibiotic consumption in each country. DDD per 1,000 inhabitants per days and per mg/PCU can be found elsewhere.

We’ve chosen to communicate antibiotic consumption in simple terms like grams and tonnes of antibiotics so that anyone can easily figure out their antibiotic consumption – and calculate their antibiotic usage ‘per person’s lifetime’ or ‘per consumer product’.

A :We used open-access UK (Public Health England, 2016) and ESAC-net (ESAC-Net) data in 2013 as a baseline. The 2013 UK data provides detailed data of antibiotic usage in tonnes, while ESAC-net provides the data in terms of DDD per 1,000 people per day. Using those data as a baseline and ESAC-net data in 2015, we estimated tonnes of antibiotic use in humans in Europe in 2015 and will apply to ESAC for more data in the future.

A: We aim to expand our Antibiotic Footprint tools by providing more data and information. For example, we will provide an individual calculator so that anyone can calculate their own Antibiotic Footprint. You could also compare your own Antibiotic Footprint with your friends, or with people in the same or other countries. Here are some examples of future campaign questions:
      - When was the last time you took antibiotics?
      - Was that possibly overuse?
      - How many times have you had antibiotics since birth?
      - How many times were possibly overuse?
      - Do you know how many grams of antibiotics were used to raise the chicken that you are eating?
      - Which meat has a low Antibiotic Footprint?
      - How can you reduce your own and your country’s Antibiotic Footprint to a minimum?