Abstract
Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives.Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed.Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries.Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29–40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7–11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen.Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.
Highlights
There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action
Excessive and non-rational use of antibiotics have resulted in increasing rates of antimicrobial resistance (AMR) worldwide, with ongoing initiatives to address this including addressing issues of governance (WHO, 2011, 2015; Collignon et al, 2015; Shallcross et al, 2015; Jinks et al, 2016)
Irrational use of antibiotics includes the prescribing and dispensing of antibiotics for upper respiratory tract infections (URTIs), which are the principal infections seen in ambulatory care and are predominantly viral in origin (Llor and Bjerrum, 2014; Dyar et al, 2016; Aabenhus et al, 2017)
Summary
There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. Excessive and non-rational use of antibiotics have resulted in increasing rates of antimicrobial resistance (AMR) worldwide, with ongoing initiatives to address this including addressing issues of governance (WHO, 2011, 2015; Collignon et al, 2015; Shallcross et al, 2015; Jinks et al, 2016). This is essential given the low number of new antibiotics in development; there are activities to try and improve the situation (O’Neill, 2015; Tacconelli et al, 2018). Inappropriate prescribing, as well as dispensing without a prescription, are enhanced by patient pressure, sub-optimal knowledge about antibiotics and viral infections among key stakeholder groups and fears among physicians and pharmacists that if they do not prescribe or dispense an antibiotic patients will go elsewhere (Jorgji et al, 2014; Yu et al, 2014; Hassali et al, 2015; Bai et al, 2016; Eslami et al, 2016; Kibuule et al, 2016; Chang et al, 2017)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
