Number Of Defined Daily Doses Research Articles

Time trends and regional variation in utilization of antidiabetic medicines in China, 2015-2022.

To assess the use of non-insulin antidiabetic medicines in China. We analysed the national procurement data for 29 non-insulin antidiabetic medicines from nine subgroups in China from 2015 to 2022. We estimated the number of defined daily doses (DDDs) procured per year in seven regions of China for nine subgroups and adjusted the data by the number of patients with diabetes. For each subgroup, the regional ratio was calculated by comparing the procurement per patient in each region with the procurement nationwide. The regional disparity was the difference between the highest and lowest regional ratios. We compared the medication patterns across regions. Nationally, between 2015 and 2022, the number of DDDs per patient increased from 14.45 to 47.37. The two most commonly used categories were sulphonylurea and biguanides, which increased from 7.04 to 15.39 (119%) and 3.28 to 11.11 (239%) DDDs per patient, respectively. The procurement of new drugs (dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists) increased quickly and had >5000% relative changes. Particularly for sodium-glucose cotransporter type 2 inhibitors, it increased from 0.08 to 5.03 DDDs (6662%). The southwest region had the highest relative change (319%), while the southern region had the lowest (118%). Biguanide and thiazolidinediones had the lowest (1.19) and highest level (2.21) of regional disparity in 2022, respectively. The procurement of non-insulin antidiabetic medicines in China has increased a lot from 2015 to 2022. In terms of DDDs per patient, sulphonylurea ranked first, followed by metformin. The procurement of new drugs increased greatly. A large regional disparity existed in medicine usage and patterns.

PARACETAMOL AND BLOOD PRESSURE CONTROL IN 45211 PATIENTS TREATED FOR HYPERTENSION: A CROSS-SECTIONAL STUDY FROM THE SWEDISH PRIMARY CARE CARDIOVASCULAR DATABASE

Objective: Paracetamol (acetaminophen) is widely recommended for analgetic and antipyretic indications due to its perceived high safety. However, studies have shown contradicting results regarding the effect of paracetamol on blood pressure (BP). We aimed to study how regular paracetamol use could affect BP control in patients on antihypertensive mediation. Design and method: Data for 42 511 patients attending primary care and a documented diagnosis of hypertension before 2007 (to rule out new onset of hypertension) and with 1 or more BP measurements recorded 2007–2008 were collected from the Swedish primary care cardiovascular database (SPCCD). There were 8 367 paracetamol users, defined as 1 or more dispensed prescriptions 6 months prior to the last BP recorded, and 34 144 non-users of paracetamol. Target BP was set to <140/90 mm Hg. Dose-response relationships were examined by the number of defined daily doses (DDD) dispensed. Multivariate linear regression analyses accounted for potential confounders. Results: Paracetamol users were older, had higher creatinine levels, more often diabetes, cardiovascular diseases and musculoskeletal diseases, and lower educational level than non-users (all P < 0.001), but attained target systolic and diastolic BP to similar degrees (58 and 93% vs 58 and 92%, respectively). There were no relations between number of DDD and systolic and diastolic BP in paracetamol users, also when DDD deciles were evaluated to account for the low proportion of patients with high DDD dispensed (all R2 <0.001). Sensitivity analyses including dispensed prescriptions of paracetamol 3 months before and 6 months after the first BP measurement provided similar results. Paracetamol had no impact on attaining target BP in subgroup analyses on patients with diabetes, musculoskeletal diseases, with concomitant use of NSAID, or in relation to number of antihypertensive medications (suggesting severity of hypertensive disease). Conclusions: Concomitant use of paracetamol does not impair the ability to reach target BP in hypertensive patients. No dose-response relationship was observed between dispensed prescriptions of paracetamol and BP.

Biosimilar competition in European markets of TNF-alpha inhibitors: a comparative analysis of pricing, market share and utilization trends.

Background: Factors like the number of biosimilar competitors and competitive pricing strategies from originator companies may influence price competition and biosimilar uptake. Objective: The aim of this study was to analyze multiple facets of biosimilar competition of TNF-alpha inhibitors in Europe by exploring the existence of a biosimilar first-mover advantage, pricing strategies of originator companies, and the evolution in patient access. Methods: Sales and volume data on biosimilar and originator infliximab, etanercept, and adalimumab between 2008 and 2020 were provided by IQVIA. Countries included 24 European Union Member States, Norway, Switzerland, United Kingdom, Serbia, and Bosnia and Herzegovina. Sales value was expressed as ex-manufacturer price per defined daily dose (DDD), and volume data were transformed into the number of DDDs per 1,000 inhabitants per day. Descriptive analyses were conducted based on the evolution in price per DDD, trends in biosimilar and originator market shares and utilization trends. Results: Market entry of the first biosimilars of infliximab and adalimumab resulted in a decrease of the volume-weighted average price (VWAP) per DDD by 13.6% and 0.9% on average, whilst the second biosimilars resulted in a decrease by 26.4% and 27.3%, respectively. The first and second etanercept biosimilars generated a similar decrease in the VWAP per DDD by 9.3% and 9.1% on average, respectively. Average market share captured by the first biosimilars was at least twice as large as the second biosimilars for all molecules. In addition, sharp reductions in price per DDD of Humira® in most countries indicated a pricing strategy resulting in low uptake of adalimumab biosimilars. Lastly, utilization of infliximab, etanercept, and adalimumab following biosimilar entry increased by an average of 88.9%, 14.6%, and 22.4%, respectively. However, introduction of (multiple) biosimilar competitors did not necessarily translate into increase in treatment access for all three molecules across some European countries indicating a shift in utilization from one molecule towards the other(s). Conclusion: Overall, this study revealed that biosimilar entry results in increased utilization and price reduction, although at a heterogenous rate among TNF-alpha inhibitors. Observed trends in market shares indicate a biosimilar first-mover advantage whereas pricing strategies considered to be anti-competitive can limit market uptake.

Use of prescription benzodiazepines and related drugs in family caregivers: a nation-wide register-based study.

objective indicators of sleep and mental health problems in family caregivers have rarely been reported. to study the use of prescription benzodiazepines and related drugs (BZDRD) in Finnish family caregivers and matched controls. prospective follow-up in 2012-17. nationwide register-linkage study. all individuals who received family caregiver's allowance in Finland in 2012 (N = 42,256; mean age 67years; 71% women) and controls matched for age, sex and municipality of residence (N = 83,618). information on purchases of prescription BZDRD, including the number of defined daily doses (DDDs), between 2012 and 2017 was obtained from the Dispensations Reimbursable under the National Health Insurance Scheme register. Background information was obtained from national registers. more caregivers than controls used BZDRD, both among women (users per 100 person-years: 17.2 versus 15.2, P < 0.001) and men (14.6 versus 11.8, P < 0.001). These differences were largely explained by hypnotic BZDRD use. There were also more long-term BZDRD users per 100 person-years among caregivers than controls, both among women (5.0 versus 4.3, P = 0.001) and men (5.3 versus 3.8, P < 0.001). Use of hypnotic BZDRD in number of DDDs was higher in caregivers than in controls, particularly among men above 50years. Caregivers used more anxiolytic BZDRD than controls from middle age to 75years but less in the oldest age groups. higher level of BZDRD use among caregivers indicates that caregivers have more sleep and mental health problems than non-caregivers. Adequate treatment of these problems and support for caregiving should be ensured for caregivers.

First trend analysis of antifungals consumption in Lebanon using the World Health Organization collaborating center for drug statistics methodology

BackgroundAntimicrobial resistance has reached an alarming rate globally, especially in middle-income countries such as Lebanon. The development of antifungal resistance is associated with the increased population’s injudicious consumption. This study aims to measure antifungals consumption in Lebanon as a trend analysis of national data from 2004 to 2018.MethodsThis is a trend analysis of the consumption of antifungal agents in the Lebanese community. Data were obtained from the Intercontinental Marketing Statistics Database between 2004 and 2018. It measures the total consumptions per year, per drug, and the percentage of its correspondents for three routes of administration (oral, parenteral, and topical). Results were reported by Defined Daily Dose (DDD) per 1000 inhabitants per day and the total number of DDDs.ResultsCommunity consumption of antifungals in Lebanon has increased by approximately 18.64% between 2004 and 2018, as measured by the number of DDDs per 1000 inhabitants per day; and amplified by approximately 87.76% as measured by the number of DDDs. The highest consumption level was noted in 2017, with 1.52 DDDs/1000 inhabitants/day and 3,386,930 DDDs. Fluconazole was the most consumed antifungal while micafungin was the least with 6,723,869.2 (20.99%) and 48.5 (0.0002%) DDDs respectively. Topical antifungals ranked the first type consumed followed by oral and parenteral antifungals representing 51.72%, 48.24%, and 0.033% of the total consumption respectively.ConclusionThe findings from this study indicate a marked increase in antifungal consumption in the Lebanese community. This accelerates the need of implementing disease management guidelines and national antifungal stewardship. Moreover, these findings may be used in further benchmark utilization and antimicrobial resistance studies in Lebanon.

Consumption and cost trends of EGFR TKIs: influences of reimbursement and national price negotiation

BackgroundEpidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used in the treatment of EGFR mutation non-small-cell lung cancer. The Chinese government has made great efforts to improve the availability and affordability of these drugs. The aim of this study was to investigate the trends in the consumption and cost of EGFR TKIs in Nanjing, a developed city in China, and evaluate the influence of health insurance coverage and national price negotiation on drug consumption.MethodsData about EGFR TKIs applications in 2010–2019 were extracted from Jiangsu Medicine Information Institute. Five types of EGFR TKIs were included. Consumption was expressed in defined daily doses (DDDs) and expenditure. The correlation between defined daily cost (DDC) and DDDs was analyzed by Pearson's correlation test.ResultsThe DDC, number of DDDs and expenditure of EGFR TKIs changed little from 2010 to 2015. National price negotiation was initiated as a policy and low-price generic gefitinib came into the market in 2016. Three types of EGFR TKIs moved into the coverage of the national health insurance since 2017. Hence, the DDC decreased, and the number of DDDs increased significantly year by year since 2016. The first generation TKIs always made up of comprised the majority of the total consumption. The predominantly prescribed TKIs were gefitinib and icotinib. DDC was negatively correlated with the number of DDDs. The number of DDDs increased significantly after health insurance enrollment, price negotiation and generic drug replacement.ConclusionThe consumption of EGFT TKIs has increased and the DDC of EGFR TKIs has decreased since 2016. These trends may be attributed to drug reimbursement, price negotiation and generic drug replacement. Further efforts are needed to translate the high consumption of EGFR TKIs into clinical benefits.

Costs and consumption of analgesics, with special reference to opiates in Serbia and Montenegro from 2015 to 2019

Background/Aim. Patients in developing countries do not always receive adequate pain-relieving treatment. Monitoring analgesics consumption is of great importance since this can help assess the quality of painful condition management. The aim of this paper was to present a five-year consumption and costs of drugs with analgesic effects in developing countries, exemplified by Serbia and Montenegro, and indicate the main reasons for their (in)adequate prescribing. Methods. The observational, retrospective, cross-sectional study was conducted in order to analyze the consumption of all analgesics, both opioid and non-opioid, in Serbia and Montenegro, as developing countries. The data concerning analgesic consumption and drug prices were obtained from annual editions of the publications of the Medicines and Medical Devices Agency of Serbia and Montenegro. The World Health Organization methodology with defined daily dose (DDD) as a unit of measure (defined by the number of DDD per 1000 inhabitants per day) was used in these publications. Results. Over the course of five years (from 2015 to 2019) in Serbia, the total allocations for analgesic therapy had a rising trend, from about 43.6 million to 63.3 million euros, while in Montenegro, expenditures showed annual variations with the highest value in 2018. Most of the money in both countries was invested in the M01A group of drugs, for which the highest consumption was also recorded. Significantly higher consumption of opioid analgesics in Montenegro compared with Serbia was observed in the same period, and it predominantly reflected the difference in fentanyl (N02AB03, transdermal patch) prescribing. In Montenegro, consumption of the M01AB group of drugs was prominently higher in comparison to the M01AE drugs group during the whole five-year period, like in Serbia, in which this was not the case just in 2018. Conclusion. Taking into account the importance of analgesics for everyday medical practice, more rational prescribing of these drugs is necessary both in Serbia and Montenegro in the future.

Antimicrobial use on 74 Japanese pig farms in 2019: A comparison of Japanese and European defined daily doses in the field

Defined daily doses (DDD) have been established in human medicine to standardize the measurement of treatment in a population. In veterinary medicine, the European Medicine Agency published defined daily dose (DDDvet) values for antimicrobial agents used in food-producing animals in 2016. National defined doses (DDDjp) for antimicrobials used for pigs in Japan have recently been determined. The aim of this study was to compare the results of calculated antimicrobial use in the field using the DDDjp and DDDvet values. Data from 74 pig farms in Japan relative to antimicrobial use in 2019 was collected. The numbers of DDDs (the weight of biomass treated in kg-days) using DDDjp and DDDvet values for each farm and for different antimicrobial classes were compared. Associations between calculated numbers of DDDjp and DDDvet on farm level were investigated. In addition, differences in antimicrobial use were investigated between different production types of farms (farrowing, finishing and farrow-to-finish farms). Using DDDjp and DDDvet values, the aggregated number of DDDs for 74 farms were 4,099,188 and 2,217,085 respectively, with the former being larger by 1.85 times than the latter. The most frequently used antimicrobial class was penicillin regardless of whether DDDjp or DDDvet was used. The absence of DDDvet values for certain antimicrobial agents used in Japan and the differences in the number of DDDjps/PCU and DDDvets/PCU indicated the need for Japanese DDDs. The number of DDDs per kg population correction unit (PCU) per farm tended to be higher in farrowing farms than in farrow-to-finish farms and finishing farms, with no significant difference (P = 0.19).

Purchase of carbapenems in Vietnam, a low- to middle-income pharmaceutical market with a high burden of antimicrobial drug resistance

Carbapenems are the last-resort antibiotics used for the treatment of multidrug-resistant bacterial infections. We reported the expenditure and prices of carbapenems in public healthcare institutions in Vietnam. Data on carbapenem procurement were obtained from tender-winning bids from provincial health authorities and public hospitals from 2013 to 2018. We use the anatomical therapeutic chemical index 2019 and the defined daily doses (DDDs) to describe the purchase (in number of DDD) and the price of carbapenem (presented in US dollar per DDD). There are four available carbapenems in Vietnam between 2013 and 2018. Imipenem/cilastatin was the most common purchased antibiotic, accounting for 50.7% of total carbapenem consumption. The vast majority of carbapenem purchase (in DDD) was imported (79.1%). By 2018, among available carbapenems, the average price of doripenem was the highest (US $85.25/DDD), followed by meropenem (US $39.4/DDD), imipenem/cilastatin (US $36.5/DDD), and ertapenem (US $24.5 per DDD). The average carbapenem price decreased by 6.3% annually. The price of doripenem (P = -0.8518, r = 0.0313) and meropenem (P = 0.8875, r = 0.0183) had a significant correlation with the number of manufacturers in the market. The price variability and the number of manufacturers of doripenem (P = 0.8173, r = 0.047) and meropenem (P = -0.8116, r = 0.499) also had a strong positive correlation. The price of carbapenems in the Vietnam pharmaceutical market was high. Monitoring the price and consumption of last-resort antibiotic are needed to ensure availability of antibiotics in the setting with high burden of antibiotic drug resistance.

Measurement of antibiotic consumption in surgical ward of a tertiary care hospital

Background: Antibiotic resistance is a global health problem. Improper use of antibiotics leads to development of antibiotic resistance, side effects, superinfections and increase in treatment costs. There are few publications on antibiotic consumption. Serious morbidity and mortality are associated with postoperative wound infections. The use of peri or pre-operative antibiotics has resulted in a reduced risk of postoperative infection when appropriate principles of prophylaxis are applied.Methods: An observational study during a 2-month period was carried out in the department of surgery of Veer Surendra Sai Institute of Medical Science and Research, Burla. We utilized the administrative data for expression of antibiotic consumption using anatomical therapeutic classification (ATC) / defined daily dose (DDDs) methodology. The information included were drug names, strength, pharmaceutical form, quantity dispensed, total number of patients admitted during the study period and average length of stay. Each drug was then given a code according to the ATC classification. The number of DDDs and DDDs/100 bed days was calculated.Results: The most frequent antibiotic used was cephalosporin group with DDDs 62.70 DDDs/100 bed days (44.34%) followed by metronidazole with 23.10 DDDs/100 bed days (16.34%). Among cephalosporin group most common antibiotic used was ceftriaxone with 24.46 DDDs/100 bed days. The mean duration of stay was 7.2 days.Conclusions: The results of this study are similar to previous studies and it showed that there is irrational use of antibiotics as there is no antibiotic policy in our hospital. Drug utilization research should be carried out at frequent intervals to improve rational use of antibiotics.

Antimicrobial use for treatment of clinical mastitis in dairy herds from Brazil and its association with herd-level descriptors

The aims of this prospective and descriptive study were to: (a) characterize treatment profile and quantify antimicrobial consumption for treatment of clinical mastitis (CM) in dairy herds of Brazil; and, (b) determine the association of antimicrobial use (AMU) for treatment of CM and herd-level descriptors, such as herd size, average milk yield, bulk milk somatic cell count (BMSCC), bulk milk total bacterial count (BMTBC), season and housing type. Data on treatment practices were obtained from 19 of 20 dairy herds selected for the study for a period of 12 months per herd. Treatment protocols were recorded in each case of CM by the farm personnel using a form that included information at the cow- and treatment-level. The frequency of antimicrobial consumption for treatment of CM was determined monthly in units of defined daily dose (DDD) and expressed as antimicrobial treatment incidence (ATI; the number of DDD per 1,000 lactating cow-days). Mixed linear regression models were used to determine the association between log-transformed ATI and herd level descriptors. The overall monthly mean ATI was 21.9 DDD per 1,000 lactating cow-days (15.4 DDD per 1,000 lactating cow-days for intramammary compounds, and 6.4 DDD per 1,000 lactating cow-days for systemically administered antimicrobials). Among intramammary drugs, aminoglycosides had the highest ATI (11.7 DDD per 1,000 lactating cow-days), followed by a treatment with a combination of tetracycline, aminoglycoside and polypeptide (10.3 DDD per 1,000 lactating cow-days). For systemically administrated antimicrobials, fluoroquinolones (6.1 DDD per 1,000 lactating cow-days), penicillin combinations (3.9 DDD per 1,000 lactating cow-days), and the combination of sulfonamide and pyrimidine (3.6 DDD per 1,000 cows per day) were the most frequently used antimicrobials. The use of combination therapy (i.e., association of intramammary and systemically administered antimicrobials) was reported for 64.3 % of treatments at the cow-level. The AMU tended to be higher in herds with highest BMSCC. In addition, a higher AMU for treatment of CM was observed during the rainy season compared to the dry season in Brazil. This seasonal effect was mostly characteristic in herds housing cows in outdoor housing systems (i.e., paddocks).

Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016

To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016. Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC-codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated. In 2016, the dentistry-related prescribing rate of 'Antibacterials for systemic use' (J01) and 'Antiprotozoals' (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow-spectrum antibiotic penicillin V was almost never prescribed. Antibiotics typically classified as broad- or extended-spectrum were prescribed most often by Belgian dentists during the period 2000-2016. Although the DID rate of all 'Antibacterials for systemic use' (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.

Pharmacoepidemiological analysis of antimicrobial therapy for burn injury in the hospital settings

Aim : to conduct a pharmacoepidemiological analysis of antimicrobial therapy of burn injury in the hospital settings. Materials and methods . The study was based on medical records of patients with burn injuries hospitalized in the Volga University Hospital (Nizhny Novgorod) in 2018. DDD (Defined Daily Dose) analysis was used to evaluate the actual drug consumption based on the defined daily dose; DU90% (Drug Utilization 90%) analysis allowed us to assess the consumption of drugs based on their representation in the total number of defined daily doses; the “cost of illness” and ABC analyses were also used. Results and discussion . For antimicrobial agents of interest, the NDDD (Number of DDD) per year, and the NDDD/100 bed-days were determined. Among these antimicrobial agents (AMA), the largest number of prescriptions was noted for vancomycin (18.06% of treatment courses and 92.86% of patients); amikacin (15.28% of treatments and 78.57% of patients); tigecycline (13.89% and 71.43%, respectively); cefoperazone / sulbactam (12.50% and 64.29%) and co-trimoxazole (12.50% and 64.29%). The NDDD/100 bed-days value for vancomycin was 100.73, followed by amikacin and co-trimoxazole: 86.85 and 71.93 NDDD/100 bed days, respectively. Other antimicrobial agents had significantly lower consumption rates. A group containing 90% of NDDD of antimicrobial agents used for burn injury included: vancomycin – 22.30% of total consumption; а mikacin – 19.23%; co-trimoxazole – 15.93%; cefoperazone / sulbactam – 10.72%; tigecycline – 10.54%; cefepime – 6.47%; levofloxacin – 3.04%. These agents accounted for 83.33% of all drug dose prescriptions. The costs of one DDD in segments DU10% and DU90% amounted to 1976.80 rubles and 1282.58 rubles, respectively. In group A, 80% of costs were for tigecycline – 41.98%; vancomycin – 19.06%; cefoperazone / sulbactam – 6.98%; cefepime – 6.82%. The average costs of treatments with AMA from group A were 15112.45 rubles, from group B – 24082.86 rubles, and from group C – 3498.58 rubles. Implications . The AMAs most commonly used in the treatment of burn injury are vancomycin, amikacin, tigecycline, cefoperazone / sulbactam and co-trimoxazole. The use of vancomycin, tigecycline, cefoperazone / sulbactam and co-trimoxazole is associated with the highest costs of AMA therapy. In the overall spending structure, the cost of amikacin therapy represents an insignificant part (i.e., group C according to the ABC analysis). Notably, amikacin is prescribed more often than other drugs because of its high efficacy in the hospital settings and its low price. We found that more expensive AMA (ertapenem, polymyxin B, linezolid, piperacillin / tazobactam) were used when the starting regimen of antimicrobial therapy produced no adequate clinical effect. Conclusion . This pharmacoepidemiological analysis made it possible to take a broader look at the cost of AMA consumed by the patients and not only those purchased by the hospital. The results provide for a rational approach to the selection of AMA names and doses.

Analysis of the efficiency of antimicrobial treatment for community-acquired pneumonia in clinical practice

To analyze actual drug consumption based on the defined daily dose (DDD analysis) and to analyze the utilization of drugs based on their proportion of the total defined daily doses (DU90% analysis) for the antimicrobial therapy of community-acquired pneumonia (CAP) in clinical practice at a hospital in Russia. The investigation materials were the data of 117 case histories of male (51.3%) and female (48.7%) patients hospitalized with CAP at Nizhny Novgorod City Clinical Hospital Five in 2015. The investigation enrolled all the patients admitted to the hospital over the analyzed period. DDD analysis and DU90% analysis were used as study methods. DDD analysis and DU90% analysis of antimicrobial therapy for CAP were carried out at the hospital in clinical practice during a year. The annual number of defined daily doses (NDDD) for antimicrobial drugs, the number of defined daily doses per 100 bed-days (NDDD/100 bed-days), and a drug load (g) per 1000 CAP patients per day and per CAP patient per year were determined. The largest NDDD/year for CAP treatment with ceftriaxone was 376 g, or 43.43 NDDD/100 bed-days, which is much higher than that with other antimicrobial agents. The daily drug load of ceftriaxone per 1,000 CAP patients was 8.8 g, which exceeds that of moxifloxacin by 18.7 times, azithromycin and levofloxacin by 5 times, and ampicillin/sulbactam by 2.3 times. The daily drug load of ceftriaxone per CAP patient was 3.2 g, which exceeds that of of ampicillin/sulbactam by 2.3 times, levofloxacin and azithromycin by 5 times, and moxifloxacin by 19 times. It may be recommended that the proportion of cephalosporins as drugs that promote the rise of resistance in microbes and their production of extended-spectrum β-lactamases should be further limited, the proportion of penicillins be extended, and the administered ampicillin/sulbactam be added, for example, by amoxicillin/clavulanate. Penicillins contribute to the rise of resistance to a lesser degree, and the use of two different penicillin molecules specified in the guidelines for the treatment of CAP will be able to slow the process further. By the same reasoning, it is also advisable to use cefuroxime (second-generation cephalosporins) along with ceftriaxone in patients in stable condition, without impairing vital functions.

Low-dose naltrexone and opioid consumption: a drug utilization cohort study based on data from the Norwegian prescription database.

PurposeLow‐dose naltrexone (LDN) is used in a wide range of conditions, including chronic pain and fibromyalgia. Because of the opioid antagonism of naltrexone, LDN users are probably often warned against concomitant use with opioids. In this study, based on data from the Norwegian prescription database, we examine changes in opioid consumption after starting LDN therapy.MethodsWe included all Norwegian patients (N = 3775) with at least one recorded LDN prescription in 2013 and at least one dispensed opioid prescription during the 365 days preceding the first LDN prescription. We allocated the patients into three subgroups depending on the number of collected LDN prescriptions and recorded the number of defined daily doses (DDDs) on collected prescriptions on opioids, nonsteroidal anti‐inflammatory drugs and other analgesics and antipyretics from the same patients.ResultsAmong the patients collecting ≥4 LDN prescriptions, annual average opioid consumption was reduced by 41 DDDs per person (46%) compared with that of the previous year. The reduction was 12 DDDs per person (15%) among users collecting two to three prescriptions and no change among those collecting only one LDN prescription. We observed no increase in the number of DDDs in nonsteroidal anti‐inflammatory drugs or other analgesics and antipyretics corresponding to the decrease in opioid use.ConclusionsPossibly, LDN users avoided opioids because of warnings on concomitant use or the patients continuing on LDN were less opioid dependent than those terminating LDN. Therapeutic effects of LDN contributing to lower opioid consumption cannot be ruled out. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

Dementia drug consumption in the Basque Country between 2006 and 2011

ObjectiveWe evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. MethodsA retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000inhabitants per day (DHD) were calculated. ResultsConsumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Álava; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from €11.5 million in 2006 to €18.1 million in 2011. ConclusionsThis study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period.

Consumo de medicamentos para el tratamiento de la demencia en la Comunidad Autónoma Vasca durante el periodo 2006-2011

ObjectiveWe evaluated the consumption of specific medications for treating cognitive symptoms associated with AD and other types of dementia in individuals over 60 years of age between 2006 and 2011 in the Basque Country. MethodsA retrospective descriptive study was conducted. The pharmacy division of the Basque Government Department of Health provided the prescribing data for the following drugs: donepezil, rivastigmine, galantamine, and memantine. The number of defined daily doses (DDDs) and the number of DDDs per 1000 inhabitants/day (DHD) were calculated. ResultsConsumption increased by 49.72% between 2006 and 2011. There were marked differences between drugs (13.02% donepezil; 93.18% rivastigmine; 37.79% galantamine; 70.40% memantine) and Basque provinces (16.34% in Áraba; 50.49% in Bizkaia; 57.37% in Gipuzkoa). Likewise, expenditure increased from €11.5 million in 2006 to € 18.1 million in 2011. ConclusionsThis study shows increased consumption of these drugs, although there are also marked differences by province which may be due to differences in prescribing habits. Spending for these drugs rose parallel to this increase in consumption; drug prices remained stable throughout the study period.

Measuring trends of outpatient antibiotic use in Europe: jointly modelling longitudinal data in defined daily doses and packages

To complement analyses of the linear trend and seasonal fluctuation of European outpatient antibiotic use expressed in defined daily doses (DDD) by analyses of data in packages, to assess the agreement between both measures and to study changes in the number of DDD per package over time. Data on outpatient antibiotic use, aggregated at the level of the active substance (WHO version 2011) were collected from 2000 to 2007 for 31 countries and expressed in DDD and packages per 1000 inhabitants per day (DID and PID, respectively). Data expressed in DID and PID were analysed separately using non-linear mixed models while the agreement between these measurements was analysed through a joint non-linear mixed model. The change in DDD per package over time was studied with a linear mixed model. Total outpatient antibiotic and penicillin use in Europe and their seasonal fluctuation significantly increased in DID, but not in PID. The use of combinations of penicillins significantly increased in DID and in PID. Broad-spectrum penicillin use did not increase significantly in DID and decreased significantly in PID. For all but one subgroup, country-specific deviations moved in the same direction whether measured in DID or PID. The correlations are not perfect. The DDD per package increased significantly over time for all but one subgroup. Outpatient antibiotic use in Europe shows contrasting trends, depending on whether DID or PID is used as the measure. The increase of the DDD per package corroborates the recommendation to adopt PID to monitor outpatient antibiotic use in Europe.

Appropriate international measures for outpatient antibiotic prescribing and consumption: recommendations from a national data comparison of different measures

Many European countries have engaged in awareness campaigns to decrease outpatient antibiotic use and several measures have been proposed, e.g. the number of defined daily doses (DDDs) or packages per 1000 inhabitants per day, producing conflicting findings. Therefore, we set out to explore what measure is most appropriate. Outpatient data on each dispensed and reimbursed medicinal package in Belgium between 2002 and 2009 were aggregated at the level of the active substance in accordance with the Anatomical Therapeutic Chemical classification and expressed as the numbers of DDDs (WHO, version 2010), packages, treatments and insured individuals per 1000 inhabitants, insured individuals and patient contacts, per day, and in July-June years. Using these measures, time trends of outpatient antibiotic use were compared and explored in detail. Expressed per 1000 inhabitants per day, outpatient antibiotic use increased between 2002-03 and 2008-09 in DDDs, whereas in packages, treatments and insured individuals it decreased. The same was true for use expressed per 1000 insured individuals or when allowing for the decreasing number of patient contacts. Increasing numbers of DDDs per package (more items per package and higher doses per unit for amoxicillin and co-amoxiclav) explain these discrepancies. The number of packages is a more appropriate measure than the number of DDDs when assessing outpatient antibiotic use over time and the impact of awareness campaigns in countries dispensing 'complete packages'. We recommended the use of different complementary measures or caution when interpreting trends based only on DDDs.

Antibiotika-Verbrauchs-Surveillance

According to § 23 paragraph 4 of the German Infection Prevention Act (IfSG; July 2011), hospitals and clinics for ambulatory surgery are obliged to establish a continuous monitoring system of antibiotic consumption. This is aimed at contributing to an optimization of antibiotic prescription practices in order to confine the development and spread of resistant pathogens. The general requirements (restricted to hospitals) on the method and extent of data collection are provided by the national public health institution after discussion with representatives of various professional societies (Robert Koch-Institut, Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 59, 2013). The article aims to clarify these specifications and to provide background details. In agreement with national and European surveillance systems, the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) classification system recommended by the WHO should be used as reference standard. Antibiotic consumption should be expressed as the number of DDDs per 100 patient days and per 100 admissions. The categories of antimicrobials and hospital organizational units to be monitored and the time intervals in which analyses should be conducted are determined. Furthermore, various approaches of data assessment are described.