The quality of outpatient antimicrobial prescribing: a comparison between two areas of northern and southern Europe

Abstract

The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing. Outpatient antimicrobial prescription data were obtained from the National Institute for Health Data and Disease Control in Denmark, and from the Aragón Information System of Drug Consumption. The number of Defined Daily Doses (DDD) of the different substances were calculated, and the quality of the antimicrobial prescription was analysed using the 'Drug Utilization 90%' method and the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators for outpatient antimicrobial use. The majority of the prescriptions (90% of total DDD) were comprised of 14 (of 39) different antimicrobials in Denmark, based mainly on narrow spectrum penicillin, and 11 (of 59) antimicrobials in Aragón, principally broad spectrum penicillins. The quality indicators described an elevated consumption of antimicrobials and an important seasonal variation in Aragón. In Denmark, the values obtained reflected a more moderate use with minor seasonal variation. The results showed important differences between the two study areas in relation to quantity and quality of outpatient antimicrobial prescription. The data indicate an overuse (and/or misuse) of antimicrobials in the Spanish region, despite national and local guidelines. The pattern of prescription in Denmark reflects a better adherence to recommendations.