Abstract
BackgroundAntibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age.MethodologyRetrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000–2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed.Principal FindingsIn total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000–2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independent determinant for ADEs.Conclusion/DiscussionThe rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance.
Highlights
The majority of antibiotics (80%) in the Netherlands are prescribed in primary care [1]
Outpatient antibiotic consumption is higher in elderly patients than in the general population [2,3,4] and most antibiotics are prescribed in elderly patients for respiratory tract infections (RTI) [5], skin and soft tissue infections [6] and urinary tract infections (UTI) [7]
The number of antibiotic prescriptions per patient per year increased with age (p,0.001): two or more antibiotic courses were prescribed for 18% (n = 1,571) of the patients years in 18–44 years, 19% (n = 5,042) in 45–64 years, 23% (n = 3,581) in 65–79 years and 29% (n = 1571) in $80 years
Summary
The majority of antibiotics (80%) in the Netherlands are prescribed in primary care [1]. Detailed information of antibiotic prescribing in elderly is scarce. The majority of studies have been done in children, who have a high antibiotic consumption [2,8,9]. Adverse drug events (ADEs) have been described more frequently in frail elderly with co-morbidity and co-medication [10]. Elderly patients have altered pharmacokinetics, such as decreased absorption and elimination, which alters antibiotic blood levels, thereby influencing the risk of ADEs [11]. Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age
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