Abstract
Introduction: Objective of this study was to determine the quantities and patterns of antibacterial medicine (ABM) consumption in the public and private hospital outpatient settings in Colombo District. Methods: A descriptive cross-sectional study was conducted in outpatient settings of selected State and private hospital settings between 2012 and 2013. 2009-WHO methodology was adapted to suit the Sri Lankan healthcare system. Oral systemic aggregated ABM (J01) consumption data was collected and categorized using Anatomical Therapeutic Chemical classification system. It was quantified using Defined Daily Doses (DDDs), and DDDs per 1000 outpatients per day (DID). Results were interpreted using descriptive statistics. Results: ABM consumption was 4.21DID and 3.46DID from private and State hospitals respectively. Most common ABM subgroup was penicillin in both private (1.34 DIDs) and State hospitals (2.67 DIDs) followed by macrolides (private hospital = 0.79 DIDs, State hospital = 0.36 DIDs). Five ABMs contributed to 90% drug utilization in State hospitals compared to 12 in private hospitals. Ratio of the consumption of broad spectrum penicillins: narrow spectrum penicillins, cephalosporins and macrolides were 30:1 and 04:1 in private and State hospitals respectively. Amoxicillin (60.3 %) was the predominantly consumed ABM in State hospitals compared to co-amoxiclav (22.9%) in private hospitals. Conclusion: Consumption of conventional ABM predominates in State outpatient settings whereas newer broader spectrum ABM in private hospital outpatient settings. The findings highlight the need for antimicrobial stewardship, especially in private hospital outpatient settings. Furthermore, the Ministry of Health, Nutrition and Indigenous Medicine of Sri Lanka should intervene to maintain complete ABM dispensed data of institutionalized ABM consumption surveillance in Sri Lanka.
Highlights
Objective of this study was to determine the quantities and patterns of antibacterial medicine (ABM) consumption in the public and private hospital outpatient settings in Colombo District
In private hospital outpatient settings, Watch group ABM agents accounted for 41% whereas
Penicillin was the main ABM subgroup consumed as reported by initial studies carried out in Sri Lanka.[24]. The ABM consumption pattern of Colombo District is similar to other countries as well.[25]. The remarkable variation seen in consumption of antibiotic subgroups between State and private sectors were most probably due to policy regulations in the State sector and profit margins in the private sector: This explains the predominant use of narrow spectrum ABMs in the State outpatient facilities and broad-spectrum ABMs in the private hospital outpatient settings. [5, 26]
Summary
Objective of this study was to determine the quantities and patterns of antibacterial medicine (ABM) consumption in the public and private hospital outpatient settings in Colombo District. ABM consumption surveillance is needed to generate data to initiate relevant policies to reduce ABM consumption and ABR, and to preserve lifesaving ABMs.[2] The World Health Organization defines antibacterial consumption data as “estimates derived from aggregated data sources such as import or wholesaler data, or aggregated health insurance data where there is no information available on the patients who are receiving the medicines or why the antimicrobials are being used These data sources provide a proxy estimate of use of antimicrobials”.(3) These consumption data can be collected and presented as total consumption for a country or by settings such as community vs hospital or State vs private sectors. The 2009-methodology recommends using bulk and prescription data which were considered as good attributes for initiating ABM consumption /use surveillances.[5]
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