Trends in Antibiotic Consumption and Resistance in Portugal, 2013–2023

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Background: Antimicrobial resistance (AMR) remains a major public health challenge globally and in Portugal, where antibiotic consumption has historically exceeded European averages. In response, the Plano Nacional de Prevenção da Resistência aos Antimicrobianos (National Programme for the Prevention of Antimicrobial Resistance) 2019–2023 established national targets to reduce inappropriate prescribing, consumption, and resistance.

Objectives: To analyse national trends in antibiotic consumption and resistance in Portugal between 2013 and 2023, and to evaluate progress relative to the 2019–2023 national program targets.

Methods: Surveillance data from 2013–2023 were obtained from the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO), and the Direção-Geral da Saúde (DGS). Four indicators were analysed in line with the 2019–2023 National Programme for the Prevention of Antimicrobial

Resistance targets: outpatient antibiotic consumption, hospital carbapenem use, prevalence of methicillin-resistant Staphylococcus aureus (MRSA), and prevalence of carbapenem-resistant Klebsiella pneumoniae. Results were compared against national targets and EU/EEA averages.

Results: Between 2013 and 2023, outpatient antibiotic consumption in Portugal increased and exceeded the 2023 national programme target, remaining above the EU/EEA average. Broad-spectrum antibiotics continued to account for a disproportionate share of prescribing. Hospital carbapenem use remained within national ceilings but above EU means. Resistance trends showed marked progress in reducing MRSA prevalence, which fell below the 2023 national programme target (<35%). Carbapenem-resistant K. pneumoniae approached, but did not exceed, the ceiling (15%). Compared with EU averages, Portugal demonstrated higher resistance rates for both MRSA and CR-Kp, though the gap has narrowed over time.

Conclusion: Portugal achieved measurable progress in stewardship during 2013–2023, particularly in reducing MRSA prevalence. However, outpatient antibiotic consumption increased during this period and exceeded programme targets, and carbapenem resistance in Gram-negative pathogens continues to pose a critical threat. Sustained, targeted stewardship interventions, especially in primary care, are essential to consolidate and expand national progress.