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Title page 1

Contents 4

Acknowledgements 6

Abbreviations 7

Glossary 8

1. Introduction 10

1.1. Background 10

1.2. Purpose and structure of this Manual 10

1.3. Overview of WPRACSS 11

1.4. Participation in WPRACSS 13

2. WPRACSS methodology for AMC surveillance at the national level 14

2.1. The ATC/DDD system 14

2.2. Antimicrobials for consumption surveillance 15

2.3. Data collection 16

2.3.1. AMC data 16

2.3.2. Population data (denominator) 18

2.3.3. Contextual information 18

2.4. Key metrics and indicators for AMC at the national level 19

3. Establishing a national AMC surveillance system 21

3.1. Structures and governance 21

3.2. Objectives and methodology 22

3.3. Selecting data sources 23

3.4. Data collection and validation 26

3.5. Data analyses 28

3.6. Sustainability 32

4. Conclusion 33

References 34

Annex 1. Situation analysis questionnaire for the national AMC surveillance system 35

Annex 2. ATC/DDD for combination products 38

Annex 3. Overview of the WPRACSS templates 41

Annex 4. Technical guide for use of basket ATC code 49

Annex 5. Draft terms of reference - Technical Working Group on National AMC Surveillance (TWG-AMC) 52

Tables 5

Table 1. Comparison of mandatory variables of the three options for AMC data collection 18

Table 2. Key indicators and metrics for AMC surveillance at the national level 20

Table 3. Data sources for AMC surveillance at the national level and their strengths and limitations 24

Table 4. Examples of data errors and their corrections 27

Table 5. Examples of questions that may be answered by AMC data 31

Figures 5

Fig. 1. Overview of WPRACSS 11

Fig. 2. WPRACSS web portal snapshot 12

Fig. 3. Depiction of the basket-level methodology for ATC3 group J01A 17

Fig. 4. The Plan-Do-Study-Act (PDSA) cycle 22

Fig. 5. WPRACSS preferred data sources to be used for AMC surveillance at the national level 23

Fig. 6. National Data Dashboard 29

Fig. 7. Regional Dashboard 30

Fig. 8. Six steps for establishing a national AMC surveillance system 33

Boxes 14

Box 1. The five levels of the ATC classification system 14

Box 2. Example of calculating AMC in DDDs 15

Box 3. Core antimicrobials for consumption surveillance 15

Box 4. Optional antimicrobials for surveillance 16

Box 5. Examples of calculating DID 19

Annex Tables 5

Table A1. Basket ATC code categories 49

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