Abstract
Background: Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. Methods: Use of antibiotics from 2014–2019 was analyzed using dispensing data from community pharmacies claimed to the statutory health insurance (SHI) funds. Quality of regional antibiotic use in 2019 was assessed by calculating indicators based on defined daily doses per 1000 SHI-insured persons per day (DID). Oral cephalosporin and fluoroquinolone use was followed by linear regression analyses. Results: The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. In 2019, DID varied from 1.62 in Brandenburg to 3.17 in Rhineland-Palatinate for cephalosporins and from 0.47 in Brandenburg to 0.89 in Saarland for fluoroquinolones. The city-states Hamburg, Bremen, and Berlin showed highest quality with the applied indicator set. From 2014–2019, a significant decrease in utilization of oral cephalosporins was found in all federal states. During 2017–2019, all states showed a significant decline of fluoroquinolone use.
Highlights
Overuse and misuse of antibiotics have favored the development of bacterial resistance which is a public health problem worldwide [1]
The following applies to all quality indicators: Values in the first quartile have the highest quality in the evaluation
High seasonal variation in DID may suggest that a large proportion of oral cephalosporins were prescribed for respiratory tract infections (RTI), and most likely not according to guideline recommendations and inappropriately, in the respective states
Summary
Overuse and misuse of antibiotics have favored the development of bacterial resistance which is a public health problem worldwide [1]. Of particular concern is the use of cephalosporins and fluoroquinolones Broadspectrum penicillins, such as amoxicillin belong to antibiotics of first choice for the treatment of respiratory tract infections (RTI), whereas cephalosporins should be avoided because of their potential of provoking resistance among Gram-negative bacteria, such as selection of extended-spectrum beta-lactamases and to increase the risk of Clostridium difficile infections [9,10]. Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. Results: The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. During 2017–2019, all states showed a significant decline of fluoroquinolone use
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