Consumption Of Antibacterials Research Articles

Comprehensive pharmacoepidemiological and clinical-economic analysis of antibacterial drugs consumed during the pandemic at the hospital level in Aktobe, Kazakhstan

<b>Aim: </b>The study aimed to analyze the frequency and structure of antibacterial drug consumption during the COVID-19 pandemic at a dispensary hospital in Aktobe, Kazakhstan. It sought to identify the most frequently used and most costly antibacterial drugs, assessing their economic impact and usage patterns.<br /> <b>Methods:</b> This descriptive, retrospective clinical, economic, and pharmacoepidemiological study was conducted using data from the dispensary hospital's pharmacy and patient records between March 13, 2020, and December 31, 2020. The ABC/VEN analysis and ATC/DDD methodology were applied to evaluate the consumption of antibacterial drugs. Antibiotics were classified according to WHO AWARe criteria.<br /> <b>Results:</b> The study found that 27 different antibacterial drugs were used, representing 2.2% of all medications. The ABC/VEN analysis revealed that the majority of the budget was spent on a few high-cost drugs. Ceftriaxone was the most commonly used antibiotic, with a significant financial impact. According to the WHO AWaRe classification, most antibiotics fell into the Access and Watch categories.<br /> <b>Conclusion:</b> The study highlights a high rate of antibacterial drug usage, with significant financial implications for the hospital. The predominance of certain high-cost antibiotics, like ceftriaxone, indicates a need for more rational and cost-effective use of these medications. The findings call for improved adherence to clinical guidelines, enhanced education for medical professionals, and optimized antibiotic utilization to prevent resistance development and ensure better patient outcomes, especially in pandemic situations.

Rebound in community antibiotic consumption after the observed decrease during the COVID-19 pandemic, EU/EEA, 2022.

We observed a rebound in consumption of antibacterials for systemic use (ATC J01) in the community sector in the European Union/European Economic Area during 2021 and 2022, after an observed decrease between 2019 and 2020. The rates in 2022 returned to pre-COVID-19-pandemic levels and were exceeded in 13 countries. Although these patterns could partly be a result of changes in disease transmission during the study period, it could also reflect a lost opportunity to strengthen and reinforce prudent antibiotic use.

Pharmacoepidemiological Analysis of Antibacterial Agents Used in a Provisional Hospital in Aktobe, Kazakhstan, in the Context of COVID-19: A Comparison with the Pre-Pandemic Period.

In the context of the global spread of Coronavirus Disease 2019 (COVID-19), the issue of evaluating and optimizing the use of antibacterial drugs becomes especially relevant. The coronavirus pandemic has provided a unique opportunity to study the dynamics of the consumption of antibacterial agents and their impact on public health. The rational use of antibiotics is a key aspect of the fight against antimicrobial resistance, which makes this study particularly important. The aim of this study was to assess changes in the consumption of antibacterial drugs among patients hospitalized with COVID-19 during the peak of the 2020 pandemic and compare them with data from 2019 prior to the pandemic. This study collated data on antibacterial drug consumption in a regional hospital in Aktobe, which served a large population of patients during the pandemic. A pharmacoepidemiological study was conducted using the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) methodology. The pharmacoepidemiological study using the international ATC/DDD methodology revealed a concerning pattern of irrational consumption of antibacterial drugs, including cephalosporins, azalides, second-generation fluoroquinolones, and systemic aminoglycosides in Aktobe. Among antibacterial drugs during the pandemic, the most significant increase in consumption was from the group of cephalosporins (19,043 DDD/100 bed-days). The share of their consumption was 35.4% of the total consumption of antibacterial drugs. Pharmacoepidemiological studies using the international methodology ATC/DDD showed an alarming picture of irrational consumption of antibacterial drugs of the group of cephalosporins, azalides, fluoroquinolones, and aminoglycosides in Aktobe, and, in this case, excessive use of the identified antibiotics raises concerns about the possibility of increasing the problem of resistance to microbes.

Antibiotic use in pediatric acute care hospitals: an analysis of antibiotic consumption data from Germany, 2013–2020

BackgroundAntimicrobial stewardship (AMS) programs are effective tools for improving antibiotic prescription quality. Their implementation requires the regular surveillance of antibiotic consumption at the patient and institutional level. Our study captured and analyzed antibiotic consumption density (ACD) for hospitalized pediatric patients.MethodWe collected antibacterial drug consumption data for 2020 from hospital pharmacies at 113 pediatric departments of acute care hospitals in Germany. ACD was calculated as defined daily dose (DDD, WHO/ATC Index 2019) per 100 patient days (pd). In addition, we analyzed the trends in antibiotic use during 2013–2020.ResultsIn 2020, median ACD across all participating hospitals was 26.7 DDD/100 pd, (range: 10.1–79.2 DDD/100 pd). It was higher at university vs. non-university hospitals (38.6 vs. 25.2 DDD/100 pd, p < 0.0001). The highest use densities were seen on oncology wards and intensive care units at university hospitals (67.3 vs. 38.4 DDD/100 pd). During 2013–2020, overall ACD declined (− 10%) and cephalosporin prescriptions also decreased (− 36%). In 2020, cephalosporins nevertheless remained the most commonly dispensed class of antibiotics. Interhospital variability in cephalosporin/penicillin ratio was substantial. Antibiotics belonging to WHO AWaRe “Watch” and “Reserve” categories, including broad-spectrum penicillins (+ 31%), linezolid (+ 121%), and glycopeptides (+ 43%), increased over time.ConclusionSignificant heterogeneity in ACD and prescription of different antibiotic classes as well as high prescription rates for cephalosporins and an increased use of reserve antibiotics indicate improvable antibiotic prescribing quality. AMS programs should urgently prioritize these issues to reduce antimicrobial resistance.

Pharmacoepidemiological analysis of the consumption of antibacterial drugs for the treatment of patients with nosocomial infections associated with previous hospitalization in multidisciplinary hospitals in the Tomsk region

BACKGROUND: Healthcare-associated infections (HAIs) are one of the common complications associated with patients stay in a medical organization. An urgent practical problem is the choice of antibiotic therapy for the treatment of patients with nosocomial infections because these infections are caused by antibiotic-resistant strains. HAIs associated with previous hospitalization (HAPH) manifest in patients after discharge from the hospital, and their risk of isolating resistant strains often remains unrecognized by specialists. Thus, more studies are required to examine the structure of HAPH pathogens and patterns of consumption of antibacterial drugs for the treatment of HAPH to further determine antibiotic therapy in these patients.&#x0D; AIMS: To analyze the use of antibiotic therapy for the treatment of HAPH with known etiological agents and the level of antibiotic resistance.&#x0D; MATERIALS AND METHODS: The study analyzed the results of a multicenter descriptive retrospective study based on the Clinics Siberian State Medical University and the State Clinical Hospital No. B.I. Alperovich (Tomsk). A total of 108 HAPH cases were examined according to the medical records of inpatients (Form 003/y). For pharmacoepidemiological analysis, the anatomical therapeutic chemical/defined daily dose (DDD) methodology was used, and antibiotic intake was assessed using the number of established daily doses. The etiological structure of HSV microorganisms was evaluated using the AMRcloud online platform. Quantitative and qualitative indicators were presented as shares (%) and absolute numbers.&#x0D; RESULTS: In total, 116 isolates from patients with HAPH were assessed. Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were the dominant pathogens causing HAPH in the overall distribution of pathogens. For the treatment of these patients, a wide range of drugs was used, including 13 groups of antibiotics. In most cases, the parenteral route of drug administration was used: intravenous route, 56.0%; intramuscular, 28.0%; and oral, 16.0%. The DDD analysis showed that antibiotic intake for the treatment of patients with HAPH was 137.8 NDDD/100 bed-days; surgical infection, 48.2 NDDD/100 bed-days (35.0%); and pneumonia, 89.6 NDDD/100 bed-days (65.0%). Cephalosporins were the most commonly used group of antibiotics for both surgical infection and pneumonia, mainly third-generation cephalosporins.&#x0D; CONCLUSION: Etiological agents of HAPH are phenotypically similar to nosocomial strains. Among antibacterial drugs, cephalosporins and fluoroquinolones were mainly consumed, and HAPH isolates had unfavorable resistance profiles to these drugs.

Antimicrobial utilization in Hajj 2022: An evaluation of quality indicators

BackgroundThe mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. MethodsAntimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. ResultsDuring Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (<25%). The overall ratio of broad- to narrow-spectrum antibiotic prescribing (J01_B/N) was 1.49. ConclusionAlthough the prescribing of β-lactams over fluoroquinolones indicates a good practice, clinicians should be reminded that most infections spreading in mass gatherings are viral; hence, do not require antibiotics. Implementation of antimicrobial stewardship is recommended to improve antimicrobial utilization.

COVID-19 pandemic and the quality of antibiotic use in primary care: an interrupted time-series study.

The coronavirus disease-19 pandemic and the related public health mitigation measures have impacted the transmission of infectious diseases; however, their impact on the use of antibacterials has not yet been extensively evaluated. This study evaluated the impact of the pandemic on the consumption patterns of antibacterials for systemic use in primary care in Portugal. An interrupted time-series analysis was performed using the autoregressive integrated moving average model of the antibacterials dispensed in the community pharmacies in Portugal from 1 January 2016 to 30 June 2022. Monthly rates of absolute consumption (all antibacterials for systemic use, and specifically penicillins; cephalosporins; macrolides, lincosamides, and streptogramins; and quinolones) and the relative consumption of antibacterials (penicillins sensitive to β-lactamase, penicillin combinations including β-lactamase inhibitors, third- and fourth-generation cephalosporins, fluoroquinolones, and the ratio of broad- to narrow-spectrum antibacterials) were estimated. Antibiotic consumption was expressed in defined daily doses per 1000 inhabitants per day (DID). In Portugal, the consumption of antibacterials (J01) declined sharply immediately after the beginning of the pandemic, having a significant reduction of >5 DID (P < .0001). A similar, short-term impact was found for penicillins (-2.920 DID; P < .0001); cephalosporins (-0.428 DID; P < .0001); macrolides, lincosamides, and streptogramins (-0.681 DID; P = .0021); and quinolones (-0.320 DID; P < .0001). A long-term increase was found for cephalosporins (+0.019 DID per month; P < .0001). Relative consumption changes were only found for third- and fourth-generation cephalosporins (0.0734%). Our study suggests that the coronavirus disease-19 pandemic may have resulted in a decrease in antibiotic use, with no significant changes in the relative dispense. Uncertainties regarding the long-term effects of the pandemic and its impact on the rates of resistance remain.

Consumption of antibacterials in three hospitals in Santiago de Cuba in the period 2019-2020

Context: Infections by multiresistant bacteria increase the risk of therapeutic failure, increasing hospital stay, costs and mortality. This determines the use of more expensive antibacterials with a broader spectrum, which leads to a high consumption at the hospital level, which increases bacterial resistance. Aims: To characterize the consumption of antibacterials in three hospitals in Santiago de Cuba. Methods: A descriptive and cross-sectional study of consumption was carried out. The consumed units, anatomical, therapeutic, and chemical classification, route of administration and price were analyzed for each antimicrobial. The defined daily dose (DDD)/100 beds/day and the cost of antibacterials for systemic use were determined. Descriptive statistics were used. Results: The most used antibacterial in both years (2019 and 2020) was ceftriaxone (12.6% and 26.9%). The most used group was J01D (39.5% and 44.8%), mainly parenteral via. In 2019 they presented higher DDD/100 beds/day: gentamicin (38.74 in the General Hospital and 20.20 in the Maternal Hospital) and ciprofloxacin (31.51 in the General Hospital and 15.00 in the Oncology Hospital); and in 2020 it was cefazolin (41.42 in General Hospital), ciprofloxacin (17.73 in Oncology) and gentamicin (26.99 in Maternal). The highest total costs were for ciprofloxacin and ceftriaxone. Conclusions: The increase in consumption evidenced the need to update therapeutic policies and validation of prescriptions for this group of drugs.

Impact of the COVID-19 pandemic on hospital antimicrobial consumption in Croatia

The aim of the study was to assess the impact of the COVID-19 pandemic on antimicrobial consumption (AMC) in the hospital sector in Croatia by analysing data reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) between 2016 and 2020. AMC was measured as the number of DDDs/1000 inhabitants/day and as the number of DDDs/100 bed days. To assess trends, linear regression was performed. To assess the impact of the pandemic on AMC, the compound annual growth rate was calculated for the years preceding the pandemic based on which AMC for 2020 was forecasted and compared with the actual consumption. While hospital AMC expressed as DDDs/1000 inhabitants/day between 2019 and 2020 decreased by 17%, when expressed as DDDs/100 bed days, an 8% increase was observed. Hospital consumption of antibacterials for systemic use in the 5 year period did not significantly change when expressed as DDDs/1000 inhabitants/day, while it statistically significantly increased when expressed as DDDs/100 bed days. An increasing trend in consumption of broad-spectrum antimicrobials was found. During the pandemic there was an increase in hospital AMC with a shift towards broad-spectrum antimicrobials requiring further in-depth qualitative analysis based on patient-level data. Contrasting results obtained using different denominators indicate that the metric DDDs/1000 inhabitants/day is not sensitive enough to evaluate hospital AMC. When assessing hospital AMC, the population under surveillance should be relevant for healthcare context. Antimicrobial stewardship remains one of the most important strategies to tackle antimicrobial resistance and antimicrobial surveillance methods must be as sensitive as possible.

СТРУКТУРА МИКРОФЛОРЫ И ТРЕНДЫ АНТИБИОТИКОРЕЗИСТЕНТНОСТИ В РЕАНИМАЦИОННО-АНЕСТЕЗИОЛОГИЧЕСКОМ ОТДЕЛЕНИИ МНОГОПРОФИЛЬНОГО УЧРЕЖДЕНИЯ

Objective. To study dynamics of structure and antibiotic resistance of microflora in the intensive care unit depending on the amount of used antibiotics. Methods. 41375 isolates were studied in the intensive care unit of a multidisciplinary hospital from 2015 to early 2021. Bacteriological examination of clinical samples on basis of Republican Scientific and Practical Center “Infection in Surgery” has been performed. The primary treatment of results with the analysis of sensitivity of microorganisms to antibiotics was carried out by means of International Computer Program (WHONET). Antibiotic sensitivity was determined by disk-diffusion method, suspended in Mueller-Hinton broth and semi-automatic analyzer ATB Expression (BioMerieux, France). The analysis of consumption of antibacterial drugs in the intensive care unit was carried out according to data of pharmacy which operates at the medical institution where the research itself was carried out. Results. From 2015 to 2017 the analysis of microflora composition permitted to establish the prevalence of P. aeruginosa (22,74%), Acinetobacter spp. (22,25%) and K. pneumoniae (16,11%) which occurred 1,6 folds more often than other microorganisms while in general structure of multidisciplinary hospital S. aureus was most common (20,96% and 20,05%). Since 2018 carbapenem-resistant K. pneumonia has dominated (23,01%). Tigecycline and colistat were not effective against 4,3% and 5,7% of K. pneumoniae isolates in 2019, 10,2% and 13,7% of isolates in 2020, 37,3% and 39,6% - from January to May 2021 which was associated with a growth of tigecycline and colistat consumption. Conclusion. Since 2018 prevalence of carbapenem-resistant K. pneumoniae has been observed in microflora of the intensive care unit which is associated with a growth of consumption of antibacterial drugs which caused appearance of K. pneumoniae isolates resistant to colistin and tigecycline. What this paper adds The relation tendency between the consumed antibacterial agents and the growth of resistance to them in the intensive care intensive care unit of a multidisciplinary institution has been firstly analyzed. The predominance of carbapenem-resistant isolates of K. pneumoniae was established starting from 2018 which led to an increase in the use of tigecycline and colistin in the treatment of patients in the intensive care unit accompanied by the appearance of isolates resistant to them at the end of 2020.

Consumption of systemic antibiotics in the Russian Federation in 2017–2021

Objective. To assess level and the structure of systemic antibiotic consumption in Russia over the period 2017 to 2021. Materials and Methods. Data were collected and analysed in compliance with the standard protocol of the World Health Organization Regional Office for Europe by the means of ATC/DDD methodology for J01 group – antibacterials for systemic use. Consumption was calculated for outpatients and inpatients separately as a number of DDDs per 1000 inhabitants per day (DID) for the main classes of antibiotics and the agents with the highest or the most diverse consumption levels for the given period of time, and was based on the data of wholesale purchases and public tenders. Results. Antibiotic consumption in Russia in 2017, 2018, 2019, 2020, and 2021 was 16.6 DID, 14.3 DID, 14.8 DID, 19 DID, and 15.7 DID respectively. Penicillins, macrolides and lincosamides, and quinolones had the highest levels of consumption in outpatients. Prominent increase in outpatient consumption of antibacterials in 2020 was related to three agents: azithromycin, levofloxacin and ceftriaxone. Cephalosporins (mainly III–V generations), quinolones and penicillins had the highest levels of consumption in inpatients. Hospital consumption of meropenem, tigecycline, and vancomycin increased and amikacin and ciprofloxacin decreased over the duration of the study. Conclusions. Levels of systemic antibiotic consumption in Russia for the period 2017 to 2019 were relatively low and consistent with the average means for European Union and European Economic Area countries. The steep increase in consumption in 2020 was probably due to the wide use of antibiotics for the management of COVID-19 patients. The results of the study can be of value for the development of targeted national antibiotic stewardship programs and awareness campaigns as well as for the analysis of trends of emergence and spread of antibiotic resistance.

Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020.

We present a European Union/European Economic Area-wide overview of the changes in consumption of antibacterials for systemic use (ATC J01) in the community between 2019 and 2020 as reported to the European Surveillance of Antimicrobial Consumption Network. Overall antibiotic consumption decreased by 18.3% between 2019 and 2020, the largest annual decrease in the network's two-decade history. We observed a strong association between the level of community antibiotic consumption in 2019 and the size of the decrease between 2019 and 2020.

Analysis of the antibiotic consumption on the backdrop of the COVID-19 pandemic: hospital level

Introduction. According to available data, the frequency of prescribing antibacterial drugs to patients hospitalized with COVID-19 is many times higher than the level of bacterial infection recorded in them. This trend may make an extremely negative contribution to the problem of antibiotic resistance in the future, which makes it important to monitor and study the consumption of antibiotics in this category of patients.Aim of the study. To estimate the change in the consumption of antibacterial drugs in patients hospitalized with COVID-19 in a multidisciplinary hospital compared with the consumption in the pre-pandemic period, and to conduct a subsequent analysis of the detected changes.Materials and methods. This retrospective study, reviewed the medical records of patients hospitalized with COVID-19 in the Moscow city hospital No. 4 in the period from April 27 to December 31, 2020, as well as medical records of patients hospitalized in the same medical institution for the same period of 2019. Results of the use of antibacterial drugs were obtained. They were evaluated using the ATC/DDD methodology and then subjected to further analysis.Results. Total consumption increased from 31,576 DDD/100 bed-days to 220,609 DDD/100 bed-days among the patients hospitalized with COVID-19. The level of consumption of macrolides increased most significantly – from 0.024 DDD/100 bed-days to 147.898 DDD/100 bed-days. The level of consumption of penicillins increased from 2,346 DDD/100 bed-days to 15,892 DDD/100 beddays, cephalosporins – from 11.78 DDD/100 bed-days to 19,107 DDD/100 bed-days, fluoroquinolones – from 10,276 DDD/100 beddays to 25,535 DDD/100 bed-days.Conclusion. The consumption of antibiotics has increased dramatically on the backdrop of the COVID-19 pandemic. Based on the data of the frequency of bacterial complications in patients with COVID-19 (no more than 8%), a more rational approach to antibacterial therapy in this group of patients is needed to reduce the potential deterioration of the problem of antibiotic resistance.

Consumption of Antibacterials for Systemic Use in Slovakia: A National Study and the Quality Indicators for Outpatient Antibiotic Use.

This paper aims to analyse the consumption of antibiotics in the Slovak health care system from 2011 to 2020. The data source on the consumption of antibiotics is sales data from SUKL and NCZI. The study employed the ATC/DDD Index and focused on the consumption of antibiotics in the primary care sector. Total antibiotic consumption decreased from 19.21 DID in 2011 to 13.16 DID in 2020. Consumption of beta-lactamase-sensitive penicillins, expressed as a percentage of the total consumption of antibiotics, decreased from 8.4% in 2011 to 4.2% in 2020. Consumption of the combination of penicillins, including beta-lactamase inhibitor, expressed as a percentage of the total consumption of antibiotics, increased from 16.2% in 2011 to 17.9% in 2020. Consumption of third- and fourth-generation cephalosporins, expressed as the percentage of the total consumption of antibiotics, increased from 2.0% in 2011 to 4.6% in 2020. Consumption of fluoroquinolones, expressed as the percentage of the total consumption of antibiotics, decreased from 10.7% in 2011 to 8.6% in 2020. Overall, antibiotic consumption significantly changed in Slovakia from 2011 to 2020. The ratio of the consumption of broad-spectrum to the consumption of narrow-spectrum penicillins, cephalosporins and macrolides decreased from 14.98 in 2011 to 13.38 in 2020.

A national survey of antibacterial consumption in Sri Lanka.

Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.

Antibacterial use by birth year and birth season in children 0-2 years in Norway

Introduction: Consumption of antibacterials in children follows seasonal cycles, and time to first treatment depends on birth season. The aim of this study was to describe dispensing rate, one-year periodic prevalence, and age at first prescription in children aged 0-2 years in Norway.Methods: We used data from the Norwegian prescription database and included all dispensed prescriptions on systemic antibacterials in 2008-2017 during the first three years of life to children born 2005-2014. We calculated age by subtracting birth month and birth year from date of collection of prescription. We used multiple linear regression to investigate the effect of birth season on age at first dispensed prescription.Results: We included 714 262 prescriptions to 281 888 individuals (53.1% boys). In 2016, one-year-old boys had the highest periodic prevalence (35.6%) and the highest dispense rate (545/1000 individuals), followed by one-year-old girls (32.6%, 478/1000 individuals). The lowest prevalence and dispense rate in all age groups was found towards the end of the period. Winter months had the highest proportion of dispensed prescriptions, and children born in autumn were significantly younger when collecting their first prescription. On average, boys collected their first prescription 26 days younger compared to girls.Conclusion: One-year-olds have the highest periodic prevalence and the highest dispense rate. This contrast with results from other studies on Norwegian data and is probably attributed to our use of birth month for calculation of age. Children born in autumn were younger when collecting their first prescription compared to other birth seasons. It is unknown whether this has any long-term clinical implications.

Consumption of tetracyclines, sulphonamides and trimethoprim, and other antibacterials in the community, European Union/European Economic Area, 1997-2017.

ObjectivesData on consumption of tetracyclines, sulphonamides and trimethoprim, and other antibacterials were collected from 30 EU/European Economic Area (EEA) countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in the composition of main subgroups of tetracyclines, sulphonamides and trimethoprim and other antibacterials.MethodsFor the period 1997–2017, data on consumption of tetracyclines (ATC group J01A), sulphonamides and trimethoprim (ATC group J01E), and other antibacterials (ATC group J01X) in the community and aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Consumption of tetracyclines, sulphonamides and trimethoprim, and other antibacterials was analysed based on ATC-4 subgroups and presented as trends, seasonal variation, presence of change-points and compositional changes.ResultsIn 2017, consumption of tetracyclines, sulphonamides and trimethoprim, and other antibacterials in the community expressed in DDD per 1000 inhabitants per day varied considerably between countries. Between 1997 and 2017, consumption of tetracyclines did not change significantly, while its seasonal variation significantly decreased over time. Consumption of sulphonamides and trimethoprim significantly decreased until 2006, and its seasonal variation significantly decreased over time. The consumption of other antibacterials showed no significant change over time or in seasonal variation.ConclusionsConsumption and composition of tetracyclines, sulphonamides and trimethoprim, and other antibacterials showed wide variations between EU/EEA countries and over time. This represents an opportunity to further reduce consumption of these groups in some countries and improve the quality of their prescription.

Consumption of antibiotics in the community, European Union/European Economic Area, 1997-2017.

ObjectivesData on antibiotic consumption in the community were collected from 30 EU/EEA countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in the composition of the main antibiotic groups.MethodsFor the period 1997–2017, data on consumption of antibiotics, i.e. antibacterials for systemic use (ATC group J01), in the community, aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Antibiotic consumption was analysed based on ATC-3 groups, and presented as trends, seasonal variation, presence of change-points and compositional changes.ResultsIn 2017, antibiotic consumption in the community expressed in DDD per 1000 inhabitants per day varied by a factor 3.6 between countries with the highest (Greece) and the lowest (the Netherlands) consumption. Antibiotic consumption in the EU/EEA did not change significantly over time. Antibiotic consumption showed a significant seasonal variation, which decreased over time. The number of DDD per package significantly increased over time. The proportional consumption of sulphonamides and trimethoprim (J01E) relative to other groups significantly decreased over time, while the proportional consumption of other antibacterials (J01X) relative to other groups significantly increased over time.ConclusionsOverall, antibiotic consumption in the community in the EU/EEA did not change during 1997–2017, while seasonal variation consistently decreased over time. The number of DDD per package increased during 1997–2017.

Change-points in antibiotic consumption in the community, European Union/European Economic Area, 1997-2017.

ObjectivesSurveillance of antibiotic consumption in the community is of utmost importance to inform and evaluate control strategies. Data on two decades of antibiotic consumption in the community were collected from 30 EU/European Economic Area (EEA) countries. This article reviews temporal trends and the presence of abrupt changes in subgroups of relevance in antimicrobial stewardship.MethodsFor the period 1997–2017, data on yearly antibiotic consumption in the community, aggregated at the level of the active substance, were collected using the WHO ATC classification and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. We applied a range of non-linear mixed models to assess the presence of changes in the consumption of antibacterials for systemic use (ATC group J01) and eight antibiotic subgroups.ResultsFor the majority of the studied groups, a country-specific change-point model provided the best fit. Depending on the antibiotic group/subgroup and on the country, change-points were spread out between 2000 and 2013.ConclusionsDue to the heterogeneity in antibiotic consumption in the community across EU/EEA countries, a country-specific change-point model provided the better fit. Given the limitations of this model, our recommendation for the included countries is to carefully interpret the country-specific results presented in this article and to use the tutorial included in this series to conduct their own change-point analysis when evaluating the impact of changes in regulations, public awareness campaigns, and other national interventions to improve antibiotic consumption in the community.

Analysing the trend over time of antibiotic consumption in the community: a tutorial on the detection of common change-points.

ObjectivesThis tutorial describes and illustrates statistical methods to detect time trends possibly including abrupt changes (referred to as change-points) in the consumption of antibiotics in the community.MethodsFor the period 1997–2017, data on consumption of antibacterials for systemic use (ATC group J01) in the community, aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology and expressed in DDD (ATC/DDD index 2019) per 1000 inhabitants per day. Trends over time and presence of common change-points were studied through a set of non-linear mixed models.ResultsAfter a thorough description of the set of models used to assess the time trend and presence of common change-points herein, the methodology was applied to the consumption of antibacterials for systemic use (ATC J01) in 25 EU/European Economic Area (EEA) countries. The best fit was obtained for a model including two change-points: one in the first quarter of 2004 and one in the last quarter of 2008.ConclusionsAllowing for the inclusion of common change-points improved model fit. Individual countries investigating changes in their antibiotic consumption pattern can use this tutorial to analyse their country data.