Anatomical Therapeutic Chemical/Defined Daily Dose Research Articles

Description Of The Usage Of Antiretroviral Medicine With Atc/Ddd Method In The Primary Health Care Centers Of Kediri 2021

AIDS (Acquired Immune Deficiency Syndrome) is a collection of symptoms and infections caused by damage to the human immune system, HIV (Human Immunodeficiency Virus ), a virus that can weaken human immunity. PLWHA patients must undergo antiretroviral virus (ARV) drug therapy, one of the drug use analysis classification systems is using the ATC/DDD system which is a means of researching drug use in an effort to improve the quality of drug use, one of these components is the presentation and comparison of drug consumption levels. international. The aim of this research is to determine the use of antiretroviral drug consumption in primary health care center in the Kediri City area for the 2021 period using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method. The design of this research is quantitative descriptive, namely describing a particular event systematically and accurately and the treatment of this research is the process of collecting data and evaluating the use of antiretroviral drugs as well as verifying Primary health care center data by interviewing primary health care center pharmacists in the Kediri city area in 2021. Consumption of antiretroviral drugs (ARVs). ) is highest in the Campurejo primary health care center, namely Lamivudine (3TC) as much as 31.71%, Balowerti in primary health care center with Zidovudine (AZT) as much as 29.02% and Pesantren 1 primary health care center with the drug Nevirapine (NVP) as much as 32.62%, while the use of ARV drugs is low. At the Campurejo primary health care center, it was 0.0002% of the drug Dolutegravir (DTG), and at the Balowerti primary health care center, it was 0.0012% of the drug Dolutegravir (DTG), then at Pesantren 1 primary health care center , it was 0.0015% of the drug Dolutegravir (DTG). The incidence of HIV is still high in Indonesia, especially in the city of Kediri.

Assessing the Impact of Antimicrobial Stewardship on Antibiotic Rationality in a Tertiary Hospital Setting

Introduction: Irrational use of antibiotics can lead to antibiotics resistance, necessitating efforts for prevention. The implementation of an Antimicrobial Stewardship Program aims to mitigate inapproriate antimicrobial prescribing. This study aims to compare antibiotic rationality based on quantity, quality, and total cost of antimicrobial utilization following the Antimicrobial Stewardship Program in a tertiary hospital setting.Methods: This was a cross-sectional study. Data were obtained from the medical record of 120 patients hospitalized in the pediatrics ward and classified into two groups: post-program and control. The quantity of antibiotic utilization was measured using Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). Antibiotic rationality was assessed using Gyssens modified category. Normality was evaluated using the Kolmogorov-Smirnov test and analyzed with an independent t-test.Results: There was 10% increase of prudent antibiotic use and a 30.61% reduction in total cost in the post-program study group. However, there was no significant difference in the quantity of antimicrobial utilization in both groups (p=0.06).Conclusion: The program improves the rationality of prudent antibiotic prescription and reduces the total cost of antimicrobial utilization.

Quantitative Evaluation of Antibiotics Use Trend in One Puskesmas in Bengkulu City: ATC/DDD and DU 90% Methods

Irrational use of antibiotics results in decreased effectiveness of antibiotics due to inappropriate use of therapeutic doses or methods of use. This causes the bacteria to become resistant to antibiotic therapy. Periodic evaluation of antibiotic use is necessary. This study aims to evaluate the use of antibiotics quantitatively in one of the Puskesmas in Bengkulu City in 2021. This type of research is descriptive research. The sample used is an antibiotic prescription in 2021 and is taken by total sampling. This research uses the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and Drugs Utilization 90% (DU 90%) methods. The results obtained were the number of prescriptions containing antibiotics as many as 1422 prescriptions (18.40%) of the total prescriptions (7730 prescriptions). The antibiotic prescriptions consisted of 1205 prescriptions for oral preparations and 217 prescriptions for topical preparations. There are 9 types of antibiotics used during 2021, namely Amoxicillin, Ciprofloxacin, Cefixime, Chloramphenicol, Gentamicin, Oxytetracycline, Levofloxacin, Tetracycline, and Tiamphenicol. The most widely used antibiotic was Amoxicillin (92.28%) with a DDDs per 1000 inhabitants per day value of 429.27 followed by Ciprofloxacin (5.06%) with a DDD value of 30.47. So it can be concluded that the most use of antibiotics in 2021 in one of the Puskesmas in Bengkulu City is Amoxicillin.

Antibiotic Resistance And Monitoring Of Antibiotic Consumption In Hospital Settings

Introduction: Antibiotics are one of the key discoveries in human history. Unfortunately, the global rise in antimicrobial drug resistance has become one of the most pressing medical problems. Monitoring of antibiotic consumption is one of the most important components of all programs aimed at controlling the problem with the rising antimicrobial resistance. Aim: The aim of this article is to present a free and internationally standardized electronic-based method for calculating the consumption of antibiotics in hospitals and in society. Methodology: The system for classification of antibiotic agents ATC/DDD (Anatomical Therapeutic Chemi-cal/Defined Daily Dose), which is an international standard for calculation of antibiotic consumption in a univer-sal technical unit of measurement—defined daily dose, is used. Practical Examples and Recommendations: The problem with the increasing antibiotic resistance was first discussed internationally at The Microbial Threat conference in Copenhagen in 1998. Monitoring antibiotic consumption is one of the key components of The European Community Strategy Against Antimicrobial Re-sistance from 2001. For the convenience of the users, open-source free software programs, incorporating the ATC/DDD system, such as ABC Calc and AMC Tool have been created for easy calculation of antimicrobial consumption. Discussion: According to the latest ECDC report, total antibiotic consumption in EU countries has been decreasing since 2014, with data for 2020 showing that antimicrobial consumption has decreased further during the first year of the COVID-19 pandemic. The only exception is Bulgaria, where it has doubled. Conclusion: ECDC data show that our country lags significantly behind other EU countries and immediate strict measures and actions are needed to combat the rising tide of antimicrobial resistance. Given the availabil-ity of free open-source programs for monitoring antimicrobial consumption, it would be very helpful to use them more widely in Bulgarian hospitals, and hospital pharmacists should play a key role in this process.

Increase and Change in the Pattern of Antibiotic Use in Serbia (2010-2019).

The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010–2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.

Utilization of Mycophenolic Acid, Azathioprine, Tacrolimus, Cyclosporin, Sirolimus, and Everolimus: Multinational Study.

Background: Organ transplantations are difficult, complicated and very expensive interventions. In order to preserve the transplanted organs, it is necessary to provide medical care to the patients in terms of immunosuppression. According to the guidelines, the first-line therapy choices for achieving immunosuppression after transplantation are tacrolimus, cyclosporine, mycophenolic acid, azathioprine, sirolimus, everolimus„ and corticosteroids. The aim of our study was to examine the utilization of this drugs in Montenegro and to compare the results with the ones from Finland, Croatia, and Serbia.Methods: In our investigation we used Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Prices per DDD of drugs are presented in euros (€).Results: In all observed countries, there is a positive trend in the consumption of all 6 drugs during the analyzed period. The prices per DDD of these drugs generally show a negative trend. Tacrolimus and mycophenolic acid in Montenegro recorded the largest reduction in the price per DDD. Price per one DDD of tacrolimus decreased from €13.28 in 2009 to €5.11 in 2019, thus by about 260%, and as regards mycophenolic acid, the price per one DDD decreased from €9.59 in 2009 to € 3.36 in 2019, thus by almost 300%.Conclusion: Despite the reduction in the price per DDD, drugs that are used as immunosuppressants are showing increasing costs from year to year. Since these drugs are expensive, they participate in a significant percentage in the budget for medicines in each country.

Medicines used in mental, neurological and substance use disorders in Gauteng, South Africa: A secondary analysis of the 2017-2018 provincial pharmaceutical database, Part 1.

BackgroundAccess to essential medicines is an integral part of effective health systems. Analysis of medicine procurement may assist with ensuring sustainable access.AimTo describe the profile and cost of medicines procured for managing mental, neurological and substance use (MNS) disorders during the 2017–2018 financial year.SettingThe study was conducted in the public health sector in the Gauteng province, South Africa.MethodA secondary analysis of the Gauteng Medical Stores Administration System database was performed. Medicine procurement for managing MNS disorders was analysed descriptively by using the World Health Organization’s Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Procurement of each medicine was evaluated in local currency (Rands) and in DDD/1000 population served. The District Health Information System was used to estimate population served.ResultsOf the total provincial medicines expenditure in 2017–2018, 3.73% was for MNS disorders, which is similar to the spending on cardiovascular (4%) and respiratory (3%) disorders. Antivirals for systemic use comprised 44% of the total expenditure, followed by vaccines at 13%. Of the medicines for MNS disorders, 32.5% of DDDs procured were for anti-epileptics (ATC N03A) at 47.5% of expenditure; 26.2% of DDDs were for antipsychotics (ATC N05A) at 30.9% of expenditure; and antidepressants accounted for 30.8% of DDDs at 6% of expenditure.ConclusionLess than 4% of provincial medicines expenditure was on medicines for MNS disorders, of which almost 78.4% of expenditure was on anti-epileptics and antipsychotics. With limited financial resources, evaluation of procurement patterns raises awareness of relative costs.

Evaluation of Antibiotics Use in Post-Surgical Acute Appendicitis Patients at ThePasuruan Regency General Hospital in 2018 (The Study Was Conducted atInpatient Installation of Pasuruan Regency General Hospital)

Acute appendicitis is an infection that occurs in vermiform appendix, and because of that it needs to do appendectomy immediately. Appendectomy is included in clean contaminated operation category which allows Surgical Site Infection (SSI). The antibiotics use in post-surgical patients to prevent the infections. The aims of this study to identify profile and determine the quantity and quality of antibiotics use. This study used cross sectional study with retrospective data on patient’s medical records after surgery for acute appendicitis in General Hospital Pasuruan Regency on January-December 2018. Data analysis was performed descriptively. The result of this study showed that the highest profile of the antibiotic use for mono therapy was Cefuroxime (25.81%) and for combination therapy were Phosphomycin + Metronidazole (8.06%) and Ceftriaxone + Metronidazole (8.06%). The quantity of antibiotics use by using Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method was obtained total DDD value 52.01 DDD/100 patient-days with the highest antibiotic was Metronidazole parenteral route 14.00 DDD/100 patient-days. Antibiotics included in Drug Utilization 90% (DU 90%) segment were (Metronidazole, Ceftriaxone, Phosphomycin, Cefuroxime, Gentamicin) by parenteral route. The quality of antibiotics use based on the Infectious Disease Society of America (IDSA) Guidelines, appropriate indication (11.86%), appropriate dose (52,54%), appropriate interval (22,03%), appropriate route (96.61%) and appropriate duration of treatment (28.81%).

Evaluasi Penggunaan Antibiotik pada Pasien Anak Rawat Inap di RSD Dr. Soebandi Jember

Infection is one of the health problems. It is mostly caused by bacteria. The increased incidence of bacterial infection results in higher antibiotic use. It can lead to antibiotic resistance risk. Antibiotic resistance may occur in pediatric patients. Morbidity, mortality, and high cost of medication are impact of this condition. Evaluation of antibiotic use needs to be done to ensure responsible use of antibiotics. ATCD/DDD (Anatomical Therapeutic Chemical/ Defined Daily Dose) method can be used to evaluate antibiotic use quantitatively. ATC classification is a system of grouping active substances according to their location of action and DDD is a measurement system that is connected to the ATC code.The purpose of this study was determining the profile of antibiotic use and measuring quantitative evaluation with ATC/DDD method in pediatric patients. The data was collected by observing the hospital medical record. The results of this study showed that cephalosporin (46,22%) was the most used group and cefotaxime (31,15%) was the most used type of antibiotic. While, the quantitative evaluation with ATC/DDD method indicated that the highest of antibiotic use was ceftriaxone (11,30 DDD/100 patient days) and the lowest was amikacin (0,03 DDD/100 patient days).

Evaluasi Penggunaan Antibiotik Pada Pasien Anak Rawat Inap di RSD Dr. Soebandi Jember

Infection is one of the health problems. It is mostly caused by bacteria. The increased incidence of bacterial infection results in higher antibiotic use. It can lead to antibiotic resistance risk. Antibiotic resistance may occur in pediatric patients. Morbidity, mortality, and high cost of medication are impact of this condition. Evaluation of antibiotic use needs to be done to ensure responsible use of antibiotics. ATCD/DDD (Anatomical Therapeutic Chemical/ Defined Daily Dose) method can be used to evaluate antibiotic use quantitatively. ATC classification is a system of grouping active substances according to their location of action and DDD is a measurement system that is connected to the ATC code.The purpose of this study was determining the profile of antibiotic use and measuring quantitative evaluation with ATC/DDD method in pediatric patients. The data was collected by observing the hospital medical record. The results of this study showed that cephalosporin (46,22%) was the most used group and cefotaxime (31,15%) was the most used type of antibiotic. While, the quantitative evaluation with ATC/DDD method indicated that the highest of antibiotic use was ceftriaxone (11,30 DDD/100 patient days) and the lowest was amikacin (0,03 DDD/100 patient days)

Utilization pattern of antibiotics and drug related problems in the orthopedic department at a tertiary care hospital: a prospective study

Background: Antibiotics are generally prescribed for both prophylactically and to treat ongoing infections in the orthopedic department. Assessment of prescribing pattern at regular interval is essential to avoid inappropriate use of drugs.
 Objectives: To know the utilization pattern of antibiotics and drug related problems like adverse drug reactions (ADR) and drug-drug interactions (DDI) in hospitalized patients.
 Materials and Methods: A cross-sectional study was conducted among hospitalized patients using WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology for one month duration in orthopedic department at a tertiary hospital. Standard data collection forms were used to collect the data. Descriptive statistics were used for analyzing the data.
 Results: Out of 196, most of patients (72.96%) were male and most of patients (34.69%) were from the age group 21-30 years. A total of 782 drugs were prescribed during study period and among them 262 were antibiotics. None of the drugs were prescribed in generic name. Ceftriaxone (33.58%) was the most frequently prescribed antibiotic. Average cost of drug therapy per patient was NPR 3125.7. DDD/100 bed-days were highest for Cefixime (27.9). A total of 233 ADRs were suspected in 64 patients (32.6%). Thrombophlebitis (26.2%) was the commonest ADR. Potential DDI were found in 51 patients (26.02%). The most common interacting pairs were Cefuroxime and Rabeprazole (15 encounters).
 Conclusion: Generic prescribing is urgently needed for cost minimization. The prevalence rate of ADR occurrence and DDI was high. The study finding benefits the hospital policy makers to formulate and address policies for rational use of antibiotics.
 Keywords: Adverse Drug Reactions; Antibiotics; Cost; Drug Utilization; Drug-Drug interaction

Retrospective Analysis of Drug Prescription Statistics in a Tertiary Care Center in India: Recommendations for Promoting Prudent Utilization of Drugs.

Objective:Drug utilization studies provide information regarding the drug usage pattern in hospital settings, which can be used to promote cost-efficient uses of drugs. The present observational retrospective study was conducted to evaluate the drug utilization pattern in a tertiary care center in India and create a baseline consumption data for the drugs, simultaneously identifying targets for improving drug prescribing pattern.Methods:The current retrospective cross-sectional study was conducted at All India Institute of Medical Sciences Raipur, wherein the 217 medical records of different departments for August 2019 were chosen randomly (using systematic random sampling) for evaluation. The information was extracted from medical records regarding the basic demographic details, drug strength, route, and total amount, and eventually, the World Health Organization (WHO) core indicators were estimated. Drug utilization data were assessed using the WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC-DDD) methodology. Potential drug–drug interactions were also analyzed.Findings:Most of the records analyzed were of male patients (56.2%). Drugs prescribed by their generic name were 50%. Prescriptions containing injection and antimicrobials were 68.1% and 83.6%, respectively. 49.3% of the patients had received a fixed-dose combination, and 60.9% of drugs belonged to the National List of Essential Medicines 2015. A total of 15 potential drug interactions were found.Conclusion:Calculated prescribed daily dose of most of the antimicrobials and other groups of drugs was close to the WHO-DDD. Trade name prescription and polypharmacy were very common. Antibiotics accounted for the majority of drug costs.

Intraperitoneal Antibiotic Utilization among Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients with Peritonitis at a Tertiary Hospital Setting in Malaysia.

ABSTRACTIntroduction:Patients receiving continuous ambulatory peritoneal dialysis (CAPD) are commonly associated with peritonitis. However, little is known about the utilization of antibiotics for the treatment of peritonitis in these patients.Objectives:This study aimed to evaluate the patterns of intraperitoneal (IP) antibiotic utilization for the treatment of peritonitis in CAPD patients.Materials and Methods:This is a retrospective study conducted at a tertiary hospital setting in Malaysia. Medical records of CAPD patients who were diagnosed with peritonitis and registered with National Kidney Registry from 2013 to 2018 were reviewed. Types of antibiotics used and its dose and duration were recorded and reported using the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.Results:A total of 105 peritonitis episodes were recorded from 72 patients. The most common first-line empirical antibiotic combinations used were ceftazidime/cefazolin (40%, n = 42), followed by cefepime/cefazolin (30.5%, n = 32) and ceftazidime/cloxacillin (25.7%, n = 27). The definitive therapy for culture-proven CAPD-related peritonitis (CAPD-P) showed that vancomycin was the most frequently prescribed antibiotic (31.7%, n = 26/82), followed by amikacin (14.6%, n = 12/82), meropenem (11%, n = 9/82) and ampicillin (11%, n = 9/82). Ciprofloxacin was among the least prescribed definitive antibiotics for CAPD-P (2.4%, n = 2/82) but the DDD/100 patient-days estimates showed that it had the highest therapeutic intensity.Conclusion:There are various IP antibiotics used for CAPD-P and the most common empirical therapy was the combination of ceftazidime and cefazolin while vancomycin is predominantly used for definitive therapy. Future studies to evaluate the clinical outcomes of the antibiotic use should be conducted to have a better insight on the efficacy of the peritonitis treatment.

The characteristics of the outpatient utilisation of medicines in the Republic of Srpska in the period 2009-2017

Background: Monitoring and measuring of the medicine utilisation enables to assess the quality of use of medicines, providing the evidence-based data for the improvement of the prescribing practice and a more rational use of medicines. The aim of this study was to analyse utilisation patterns of medicines and to compare the results with other countries. Methods: A retrospective, observational study to analyse outpatient medicines utilisation in the Republic of Srpska between 2009 and 2017. Data of medicines utilisation were retrieved from the national database in the Public Health Institute of the Republic of Srpska and calculated and analysed by using the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. The results were expressed as Defined Daily Doses (DDDs) per 1,000 inhabitants per day. Results: Total medicines utilisation increased, from 448 DDDs in 2009 to 1,036 DDDs in 2017. Cardiovascular medicines (group C) were the most used medicines, and their share in the total utilisation increased from 36.6% in 2009 to 44.4% in 2017. Among them, the most frequently used were angiotensin-converting enzyme inhibitors, plain and in combinations with diuretics, namely enalapril. The share of medicines used in diabetes in the total utilisation increased from 3.9% in 2009 to 5.1% in 2017. Metformin and glimepiride accounted for about 83% of the blood glucose lowering medicines group (A10B). Among the antithrombotic medicines, the most frequently used were platelet aggregation inhibitors (B01AC), mainly acetylsalicylic acid whose use tripled since 2009. Diclofenac was the most frequently used non-steroidal anti-inflammatory and antirheumatic drug (M01). Conclusion: The trend of increased medicines utilisation was observed in this study. This finding is comparable with other countries. Variations between countries in the preferred medicines within a class as well as the extent of medicines use were observed. These differences were probably consistent, but not solely attributable, to differences in local guidelines and reimbursement policies.

From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics

BackgroundThis study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.MethodsUtilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred.ResultsThe indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels.ConclusionsThe ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.

Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection

Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using χ2-test and multinomial logistic regression.Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (>7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.

Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India

Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class ( P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.

Antibiotic use in the Hungarian hospitals in the last two decades (1996-2015)

Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. To quantify systemic antibacterial use in Hungarian hospitals. Consumption data were analysed using the Anatomical-Therapeutic-Chemical - Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839-1846.

Higher systemic antibiotic consumption in a population of South Korea (2008 – 2009)

This study was conducted to investigate overall systemic antibiotic consumption levels and specific patterns using standardized Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. National Health Insurance claims data during 2008 and 2009 was used. Antibiotic prescription data was classified using the ATC system and converted into DDD. Consumption figures were presented as the number of DDD per 1,000 inhabitants per day (DID). Detailed information on indications and seasonal variations, age and institutional determinants on antibiotic consumption were also explored. Total consumption was slightly increased from 24.3 to 25.2 DID in 2009 compared to 2008. The most frequently prescribed antibiotic was amoxicillin/clavulanic acid (5.1 and 5.2 DID, in 2008 and 2009, respectively), followed by cefaclor (3.0 and 3.3 DID) and amoxicillin (3.3 and 3.2 DID). Respiratory system diseases were the main causes of antimicrobial prescription (47.3%) and acute forms of bronchitis, tonsillitis and sinusitis were the most common diseases. There were typical seasonal fluctuations with heightened winter peaks. Consumption figures under 5 years of age (41.6 and 43.3 DID) were even higher than figures in aged 65 - 80 (36.2 and 39.1 DID). Antibiotic consumption in South Korea remained high compared with other OECD countries. Efforts to increase prudent antibiotic use, especially for upper respiratory system infections and for younger children, should be made to decrease antibiotic use.

Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010

In Japan, a national surveillance study of antimicrobial consumption has never been undertaken. This study aimed to describe antimicrobial consumption and resistance to Pseudomonas aeruginosa in 203 Japanese hospitals, to identify targets for quality improvement. We conducted an ecological study using retrospective data (2010). Antimicrobial consumption was collected in the World Health Organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) format. Rates of imipenem (IPM), meropenem (MEPM), ciprofloxacin (CPFX), or amikacin (AMK) resistance were expressed as the incidence of non-susceptible isolates. Additionally, hospitals were asked to provide data concerning hospital characteristics and infection control policies. Hospitals were classified according to functional categories of the Medical Services Act in Japan. Data were collected from 203 Japanese hospitals (a total of 91,147 beds). The total antimicrobial consumption was 15.49 DDDs/100 bed-days (median), with consumptions for penicillins, carbapenems, quinolones, and glycopeptides being 4.27, 1.60, 0.41, and 0.49, respectively. The median incidences of IPM, MEPM, CPFX, and AMK resistance were 0.15, 0.10, 0.13, and 0.03 isolates per 1,000 patient-days, respectively. Antimicrobial notification and/or approval systems were present in 183 hospitals (90.1%). In the multivariate analysis, the piperacillin/tazobactam, quinolones, and/or total consumptions and the advanced treatment hospitals showed a significant association with the incidence of P. aeruginosa resistant to IPM, MEPM, CPFX, and AMK [adjusted R (2) (aR (2)) values of 0.23, 0.30, 0.22, and 0.35, respectively). This is the first national surveillance study of antimicrobial consumption in Japan. A continuous surveillance program in Japan is necessary in order to evaluate the association among resistance, antimicrobial restriction, and consumption.