Abstract
We provide a representative analysis of antibiotic prescribing, identify factors associated with broad-spectrum antibiotic prescribing and assess the costs associated with antibiotic use in adult outpatients in Greece. Outpatient antibiotic prescriptions for patients older than 19 years between 2010 and 2013 in Greece were extracted from the IMS Health Xponent database. Prescribing rate and total cost for prescribed antibiotics were calculated. Multivariate logistic regression was used to identify factors related to broad-spectrum antibiotic prescribing. More than 20 million antibiotics were prescribed during the study period, an annual rate of 768 prescribed antibiotics per 1,000 adults. Overall, 33.5% of antibiotics were prescribed for acute respiratory tract infections (ARTIs) for which antibiotics are often not indicated. Macrolides (29.9%), cephalosporins (26.9%) and fluoroquinolones (21.0%) were the most commonly prescribed antibiotic classes. The majority (89.0%) of antibiotics were broad-spectrum. Antibiotic expenditures were approximately EUR 185 million during the study period. Factors associated with broad-spectrum prescribing included older patient age, specialty pulmonologists or otorhinolaryngologists, training in eastern Europe, diagnosis of ARTI, acute diagnosis, and first episode of disease. Broad-spectrum antibiotic prescribing for ARTIs is common in adult Greek outpatients and frequently inappropriate. These data indicate the need for initiatives aiming to control antibiotic prescribing.
Highlights
Antibiotics are among the most frequently prescribed medications in adult outpatients in European countries such as Greece [1]
An estimated 20 million antibiotic regimens were prescribed in Greece to adult outpatients, resulting in an annual rate of 768 prescribed antibiotics per 1,000 adults, with a median duration therapy of eight days (IQR: 6.0– 10.5) (Table 1)
Prescribing rates were higher among adults younger than 40 years (830 prescriptions/1,000 adults; 95% confidence intervals (95% CI): 829.12–830.31) compared with adults 40 years and older (736 prescriptions/1,000 adults; 95% CI: 735.11–736.22), while no statistically significant difference was detected in treatment duration across the age groups (p = 0.330)
Summary
Antibiotics are among the most frequently prescribed medications in adult outpatients in European countries such as Greece [1]. There is evidence that a number of antibiotic prescriptions are dispensed for viral infections, for which antibiotics provide no benefit [2] Such prescriptions indicate an overuse of antibiotics, a common and alarming problem for many countries, potentially resulting in redundant drug spending, increased risks of adverse effects and development of antimicrobial resistance [3,4,5]. The latter is a rapidly growing global health problem [6,7,8]. There are instances where antibiotics may be indicated, but instead of prescribing narrow-spectrum antibiotics, broad-spectrum antibiotics are inappropriately preferred [12]
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