Outpatient Antibiotic Consumption Research Articles

How did the COVID-19 pandemic affect antibiotic consumption within humanitarian emergencies? Results from five humanitarian contexts

IntroductionBoth high- and low-income countries reported increased antibiotic consumption among COVID-19 patients during the first months of the pandemic. To date, however, no studies have examined changes in antibiotic consumption during the COVID-19 pandemic within humanitarian emergency contexts. MethodData was collected by Médecins Sans Frontières (MSF) for the years 2018-2021 across the following humanitarian settings: Afghanistan (Lashkar Gah), Bangladesh (Kutupalong), the Democratic Republic of Congo (Mweso and Baraka), and South Sudan (Bentiu). Inpatient and outpatient antibiotic consumption was calculated as Daily Defined Dose (DDD) per 1000 inhabitants per day, as per the World Health Organisation’s (WHO) Collaborating Centre for Drug Statistics Methodology. Interrupted time series (ITS) analysis, using an autoregressive integrated moving average (ARIMA) model was used to analyse retrospective monthly antibiotic consumption. The impact of COVID-19 pandemic was evaluated as total antibiotic consumption and according to WHO Access, Watch, Reserve (AWaRe) group classifications within each humanitarian setting. ResultsThe COVID-19 pandemic had no statistically significant impact on total antibiotic consumption in South Sudan (Bentiu) and Bangladesh (Kutupalong). Similarly, the pandemic had no impact on total antibiotic consumption in DR Congo (Baraka), despite an initial 0.27% (estimate=.274, p-value=0.006) increase in March 2020 driven by Access group antibiotics. Meanwhile, total antibiotic consumption in DR Congo (Mweso) and Afghanistan (Lashkar Gah) declined by 0.74% (estimate = -.744, p =0.003) and 0.26% (estimate = -0.26, p < 0.001), respectively with the COVID-19 pandemic. ConclusionFurther studies are required to investigate what may have contributed to these results.

Community Antibiotic Consumption in Cyprus for the Period 2015 to 2022.

Cyprus currently reports to ESAC-Net the total consumption of antimicrobials, without distinguishing between hospital and community-based antibiotic use. As a result, these data can only provide generalized insights into antimicrobial trends in the country. This study is a first attempt to retrospectively analyze community antibiotic consumption in Cyprus for the period of 2015 to 2022. Data on community antimicrobial consumption between 2015 and 2022 were extracted from Pharmatrack's database. Orally administered dispensed antibiotics were categorized under the J01 group of the WHO Anatomical Therapeutic Chemical (ATC) classification and by the WHO's AWaRe classification of antibiotics. Antibiotic consumption was calculated in both packages consumed and per 1000 inhabitants, overall, by year of consumption and districts. During the period of 2015-2022, there was variability in the mean outpatient antibiotic consumption per 1000 inhabitants among the five districts in Cyprus. Community consumption increased by 38% throughout the study period. Additionally, a decrease of 3% in the consumption of WHO 'Access' antibiotics was observed, accompanied with a concurrent increase of 3% in the 'Watch' group. Specifically, in 2022 the WHO 'Access' group consumption in the Cypriot community was 48%, significantly lower than the WHO's goal of 60% and the EU's goal of 70% for 'Access' antibiotic consumption. Antibiotic consumption in the community of Cyprus between 2015 and 2022 demonstrated substantial variability among districts, with higher consumption in less populated areas. There was an increasing trend in community consumption over the years and a decreasing trend in the percentage of 'Access' antibiotics prescribed.

Dynamics of Pediatric Antibiotic Use Differ between High- and Low-Prescribing Clinics after Pneumococcal Conjugate Vaccines

To compare dispensed oral antibiotic prescription rates (DAPRs) after implementation of pneumococcal conjugate vaccine (PCV) in high antibiotic-prescribing clinics (HPC) with low antibiotic-prescribing clinics (LPC) in 2 distinct ethnic groups of children (Jewish and Bedouin children)<5years of age. Clinics with ≥50 insured children, active both pre-PCV (2005-2009) and post-PCV (2010-2018) implementation, were included. HPC and LPC were defined by DAPRs above or below the median in each age and ethnic group. Monthly dispensed antibiotic prescription rate (DAPR) trends (adjusted for age and ethnicity) were calculated using interrupted time series. Mean yearly incidence rate-ratios (late PCV13 vs pre-PCV) were calculated. Bedouin HPC had the highest pre-PCV overall-DAPR per 1000 child-years± SD (2520.4 ± 121.2), followed by Jewish HPC (1885.5 ± 47.6), Bedouin LPC (1314.8 ± 81.6), and Jewish LPC (996.0 ± 19.6). Shortly after PCV implementation, all DAPRs and amoxicillin/amoxicillin-clavulanate DAPRs declined in all groups except Jewish LPC, stabilizing within 4-5years post-PCV. The rates and magnitudes of declines were directly proportional to the pre-PCV DAPR magnitudes, achieving near-complete closure of the pre-PCV DAPR gaps between the 4 groups (rates during late-PCV13 ranging from 1649.4 ± 23.5 [Bedouin HPC] to 1200.3 ± 72.4 [Jewish LPC]). PCVs are a powerful tool in reducing outpatient antibiotic consumption among young children, especially in HPC, resulting in partial closure of DAPR gap between HPC and LPC. The higher impact on HPC suggests that PCV-associated declines of respiratory disease may strongly contribute to a judicious antibiotic approach in clinics with high antibiotic consumption.

Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.

The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based metrics and days-supplied-based metrics. Outpatient antibiotic consumption metrics should incorporate the duration of therapy.

Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case–control study

ObjectivesThe aim was to investigate risk factors for community-onset bloodstream infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE BSI). MethodsIt is mandatory to report EPE BSI to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case–control study from 2007 to 2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status were collected from hospital and health registers. ResultsThe overall incidence of EPE BSI was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41–5.47), followed by immunological disorders, aOR 3.54 (CI 2.01–6.23), haematological malignancy, aOR 2.77 (CI 1.57–4.87), solid tumours, aOR 2.28 (1.76–2.94) and diabetes, aOR 2.03 (1.58–2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months was associated with EPE BSI, aORs 5.52 (CI 2.8–11.0) and 3.8, CI 1.9–7.7) respectively. There was a dose–response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Higher age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality. ConclusionsTargeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.

Outpatient Antibiotic Consumption for Urinary Infections in Croatia 2005 - 2014: What can be Learned from Utilization Trends.

AimThe aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014, to describe utilisation trends, and general consequences of antibiotic consumption on antimicrobial resistance.MethodsAntibiotic utilisation data were obtained from annual reports of both the Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID). Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Descriptive statistics were used to process data and calculate trends.ResultsOverall, utilisation of antibacterials decreased by 4.8% (from 3,35 to 3,19 DDD TID), while trends of individual agents varied substantially – from 87% decline for ceftibuten to 160% rise for levofloxacin. The consumption of quinolones increased by 32.3%. This was mostly due to increased ciprofloxacin consumption (144% raise). Sulfamethoxazole-trimethoprim declined by 57%, while nitrofurantoin increased by 86%. The use of fosfomycin was marginal. Antimicrobial resistance of E. coli increased against quinolones by 54.5%, and against nitrofurantoin by 2–3%. Quinolone resistance of other pathogens (Klebiella spp, Proteus mirabilis), increased variably – between 17.2% (Klebsiella) and 90% (Proteus), while for P. aeruginosa remained the same at 22%.ConclusionHigh rates of antimicrobial utilisation require prescribing restrictions and educational interventions. The increased use of fluoroquinolones is a potentially serious public health threat due to the rapid development of resistance among uropathogens. This threat can be avoided by greater use of nitrofurantoin and fosfomycin.

European Antibiotic Awareness Day (EAAD): any impact on antibiotic consumption and public awareness in Slovenia?

To evaluate the impact of European Antibiotic Awareness Day (EAAD) on antibiotic consumption, improvements in general public awareness and antibiotic resistance in Slovenia. Outpatient data for the period from 2002 to 2016 and hospital antibiotic consumption data for 2004-16 were collected using the Anatomical Therapeutic Chemical (ATC) classification/DDDs. Outpatient antibiotic consumption data were expressed in DDDs/1000 inhabitants/day (DIDs), number of packages/1000 inhabitant-days and number of prescriptions/1000 inhabitants/year. Hospital consumption data were expressed in DIDs, number of DDDs/100 bed-days and number of DDDs/100 admissions. Segmented regression analysis of interrupted time series was used to estimate the effects of these interventions on antibiotic consumption. During the 8 year period since establishing EAAD, a 9%-17% decrease in outpatient antibiotic consumption has been observed, depending on the measurement unit, which was a little more than in the 6 years prior to EAAD (7%-12%). The trend change in hospital consumption after EAAD was established remained small, with a highly non-significant P value. Eurobarometer data did not show an increase in knowledge on antibiotic use. Resistance of Streptococcus pneumoniae to penicillin and macrolides decreased during EAAD activities. EAAD activities were associated with a decreasing trend in community consumption. Owing to many other national activities on the prudent use of antimicrobials in outpatients and inpatients it is difficult to analyse the direct effect of EAAD.

Factors Related To Outpatient Antibiotic Drug Consumption In Turkey

Turkey is currently a European leader in antibiotic consumption. To fight against increasing consumption, it is necessary to understand factors related to antibiotic drug consumption. To fill this gap in the literature, this study intends to probe factors related to outpatient antibacterial drug consumption in Turkey. Data from the National Antibacterial Drug Consumption Surveillance report and the Turkish Statistical Institute were assessed. The number of physicians; socio-economic development index (SEDI); endocrine, nutritional, and metabolic disease mortality; employment; education; and geographic region were used as factors related to outpatient antibacterial drug consumption. Euclidean distance measure and complete linkage methods were used to draw a heatmap. A hierarchical cluster analysis was performed to visualize factors related to outpatient antibacterial drug consumption. Additionally, 81 provinces of Turkey were used as a decision-making unit in the analysis. Sensitivity analysis of province group differences in terms of study variables were examined using independent sample “t” and Chi-square (“X2”) tests. Study results revealed a close link between education and outpatient antibiotic drug consumption in Turkey. In addition, 81 provinces were categorized into two groups representing rural and urban regions of Turkey. The differences in province group sensitivity results – according to the number of physicians (t=2.522, p˂0.05); SEDI (t=4.986, p˂0.05); endocrine, nutritional and metabolic diseases, mortality (t=3.317, p˂0.05); employment (t=1.684, p˂0.05); antibacterial drug consumption (t=6.470, p˂0.05); and education (t=3.544, p˂0.05) – were statistically significant. The study results highlight the need to raise awareness in Turkey regarding appropriate consumption of antibacterial drugs. Antibiotic awareness campaigns, consideration of increasing cost, communication among stakeholders, and strong sustainable use policies are essential to combat increasing antimicrobial resistance in Turkey.

Antibiotics to outpatients in Norway-Assessing effect of latitude and municipality population size using quantile regression in a cross-sectional study.

High antibiotic consumption rates are associated to high prevalence of antimicrobial resistance. Geographical differences in dispensing rates of antibiotics are frequently analysed using statistical methods addressing the central tendency of the data. Yet, examining extreme quantiles may be of equal or greater interest if the problem relates to the extremes of consumption rates, as is the case for antimicrobial resistance. The objective of this study was to investigate how geographic location (latitude) and municipality population size affect antibiotic consumption in Norway. We analysed all outpatient antibiotic prescriptions (n>14000000) in Norway between 2004 and 2010 using quantile regression. Data were stratified by year, and we aggregated individual data to municipality, county, or latitudinal range. We specified the quantile regression models using directed acyclic graphs and selected the model based on Akaike information criteria. Yearly outpatient antibiotic consumption in Norway varied up to 10-fold at municipality level. We found geographical variation to depend on the number of inhabitants in a municipality and on latitude. These variables interacted, so that consumption declined with increasing latitude when municipality population sizes were small, but the effect of latitude diminished as the number of inhabitants increased. Aggregation to different levels of spatial resolution did not significantly affect our results. In Norway, outpatient antibiotic dispensing rates decreases with latitude at a rate contingent on municipality population size. Quantile regression analysis provides a flexible and powerful tool to address problems related to high, or low, dispensing rates.

Outpatient use of antibiotics in children in Slovenia

Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is estimated that up to 50 % are prescribed unnecessarily or inappropriately. To plan the actions for optimizing the use of antibiotics, we conducted a national antibiotic consumption study in children aged 0–18 years in the period between 2003 and 2015. Methods: In this national retrospective research we analyzed outpatient antibiotic consumption using ATC/DDD classification. The use of antibiotics was recorded in relation to the pattern of prescription, age, gender and health region. Results: The total consumption of antibiotics decreased by 35 % from 979 to 636 prescriptions per 1000 children/year (PTY) during the whole study period. Te use of all antibiotic classes decreased (except for quinolones and nitrofuran derivatives) by 12.5 %–81 %. In all those years we recorded the highest consumption in children aged 1 to 4 years (2184–1160 PTY). Amoxicillin was the most commonly prescribed antibiotic in children aged 0 to 4 years, penicillin V among 5 to 14 years and co-amoxiclav among adolescents aged 15 to 19 years. In health regions in the northeastern part of Slovenia much more antibiotics were prescribed than in other regions. In 2015, 65 % of prescriptions were prescribed by pediatricians and school medicine specialists, 16 % by physicians without specialization, 14 % by GPs/family doctors and 5 % by other specialists. Conclusions: Despite the decrease in outpatient antibiotic use in children and adolescents in Slovenia, the overall and especially broad-spectrum antibiotic consumption (amoxicillin with clavulanic acid, azithromycin and second/third generation cephalosporins) is still too high. It is necessary to strengthen activities to reduce prescribing, particularly for acute (upper) respiratory tract infections.

Ambulantna poraba antibiotikov pri otrocih v Sloveniji

Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is estimated that up to 50 % are prescribed unnecessarily or inappropriately. To plan the actions for optimizing the use of antibiotics, we conducted a national antibiotic consumption study in children aged 0–18 years in the period between 2003 and 2015.Methods: In this national retrospective research we analyzed outpatient antibiotic consumption using ATC/DDD classification. The use of antibiotics was recorded in relation to the pattern of prescription, age, gender and health region.Results: The total consumption of antibiotics decreased by 35 % from 979 to 636 prescriptions per 1000 children/year (PTY) during the whole study period. Te use of all antibiotic classes decreased (except for quinolones and nitrofuran derivatives) by 12.5 %–81 %. In all those years we recorded the highest consumption in children aged 1 to 4 years (2184–1160 PTY). Amoxicillin was the most commonly prescribed antibiotic in children aged 0 to 4 years, penicillin V among 5 to 14 years and co-amoxiclav among adolescents aged 15 to 19 years. In health regions in the northeastern part of Slovenia much more antibiotics were prescribed than in other regions. In 2015, 65 % of prescriptions were prescribed by pediatricians and school medicine specialists, 16 % by physicians without specialization, 14 % by GPs/family doctors and 5 % by other specialists.Conclusions: Despite the decrease in outpatient antibiotic use in children and adolescents in Slovenia, the overall and especially broad-spectrum antibiotic consumption (amoxicillin with clavulanic acid, azithromycin and second/third generation cephalosporins) is still too high. It is necessary to strengthen activities to reduce prescribing, particularly for acute (upper) respiratory tract infections.

Relationship between outpatient antibiotic use and the prevalence of bacterial infections in Montenegro.

The overuse of antibiotics unnecessarily exposes patients to risk of side effects, encourages reconsultation for similar problems and enhances antimicrobial resistance. The use of antibiotics in the year 2011 in Montenegro was high (39.05 Defined Daily Dose – DDD/1,000 inhabitants/day), but it was not considered in relation to the frequency of bacterial diseases. The aim of our study was to determine the degree of conformance between the amount of outpatient antibiotic consumption and the reported prevalence of outpatient bacterial infections in the Republic of Montenegro. Data on the use of antibacterial drugs was obtained from the Agency for Medicines and Medical Devices of Montenegro for the year 2012. The amount of antibiotics was calculated using the Anatomic Therapeutic Chemical (ATC) DDD methodology. Data on the prevalence of outpatient infective disease was obtained from the Health Statistical Yearbook 2012 of Montenegro and it was expressed per 1,000 inhabitants. A total of 30.34 DDD/1,000 inhabitants/day of antibiotics in outpatients were prescribed in Montenegro in 2012, with penicillins being most frequently prescribed. Amoxicillin and amoxicillin with clavulanic acid were the most frequently used antibiotics. The prevalence of outpatient bacterial infections was 6,745 cases or 10.87/1,000. The most frequent infections were respiratory tract infections. Less than 50% of the prescribed amount of antibiotics were prescribed in accordance with national guidelines on treatment of bacterial infections. Use of antibiotics in Montenegro in 2012 was more than double than necessary according to prevalence of bacterial infections and average duration of treatment. The structure of antibiotics was not in full compliance with the national good practice guidelines, but it was in accordance with data on bacterial antibiotic resistance in outpatient practice. It is necessary to initiate measures to rationalize the use of antibiotics both in terms of quantity and in terms of the structure of the most used antibiotics.

Susceptibility of Vascular Implants to Colonization in vitro by Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis and Pseudomonas aeruginosa.

We compared association of Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa and Enterococcus faecalis with nine vascular implants after co-culture. Vascular implants were composed of various materials such as warp knitted polyester (with or without gelatin and silver ions), expanded polytetrafluoroethylene and biological materials - surface treated porcine pericardial patch and Omniflow II. The lowest overall number of associated bacteria was detected for polytetrafluoroethylene implants and porcine pericardial patch. The highest overall number of associated bacteria was detected for Omniflow II implant. The major source of variation, i.e. primary factor influencing colonization, is the implant type (56.22%), bacterial species is responsible for only 1.81%, and interaction of those two factors - 13.09% of variation.

Trends, demographics and disparities in outpatient antibiotic consumption in New Zealand: a national study.

Knowledge of the patterns of antibiotic consumption within a population provides valuable information on when, where and to whom antibiotics are prescribed. Such knowledge is critical in informing possible public health interventions to reduce inappropriate antibiotic use. The aims of this study were to (i) determine national patterns of antibiotic consumption, including assessment of seasonal variation in prescribing, and (ii) explore potential associations between antibiotic consumption and patient characteristics, such as age, sex and ethnicity. Data on all subsidized antibiotic dispensing in New Zealand between 1 January 2006 and 31 December 2014 were obtained and stratified according to age, sex and ethnicity. Antibiotic dispensing was expressed as the number of DDDs per 1000 population per day (DID). Total antibiotic consumption in New Zealand increased by 49% from 17.3 DID in 2006 to 25.8 DID in 2014. The increase in antibiotic consumption occurred in all ages and amongst all ethnic groups. The use of extended-spectrum penicillins, which almost doubled in the study period, made a major contribution to the overall increase and was highest in young children and in Pacific peoples. Consumption of quinolones increased early in the study period and then declined from 2011 onwards. Future work should focus on identifying the appropriateness of antibiotic prescribing, particularly for penicillin prescribing in Pacific peoples and children, and on both reducing unwarranted antibiotic use and improving antibiotic selection when therapy is indicated.

Outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014

Introduction. Antimicrobial resistance is a very serious public health threat worldwide. The main cause of antimicrobial resistance is irrational use of antimicrobial drugs. The goal of the article is to analyze data on outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014, to present outpatient consumption of the first six antibiotics (the fifth level of the ATC classification), and, finally, to compare the antibiotic use in Republic of Srpska in relation to the antibiotic use in European Union countries. Materials and Methods. Collection and analysis of data on drug consumption is done using ATC/DDD methodology, established by the WHO. Data are taken from the report on drug consumption and distribution in the Republic of Srpska during the period from 2009 to 2014, which are based on submitted data from pharmacies registered in the Republic of Srpska. Results. Results on outpatient antibiotic consumption in the Republic of Srpska, during the period from 2009 to 2014, indicate a total decrease by 3.41 DDDs/1000 inhabitants/day, with the exception of 2010 and 2013, when the antibiotic consumption was increased. In 2014, total outpatient antibiotic consumption in the Republic of Srpska was 31.2% lower than the average consumption in the European Union. During the period from 2010 to 2014, the European Union had a significant increase in antibiotic consumption, while antibiotic consumption in the Republic of Srpska had a tendency of falling. Conclusion. Presented results show a quantitative analysis of antibiotic consumption and provide insight into the outpatient use of antibiotics in the Republic of Srpska, and can be used for further pharmacoepidemiological analysis of antibiotic consumption, which would give a better insight into the therapeutic practice, with the aim of improving the rational pharmacotherapy in the Republic of Srpska.

Vanbolnička potrošnja antibiotika u Republici Srpskoj u periodu od 2009. do 2014. Godine

Introduction. Antimicrobial resistance is a very serious public health threat worldwide. The main cause of antimicrobial resistance is irrational use of antimicrobial drugs. The goal of the article is to analyze data on outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014, to present outpatient consumption of the first six antibiotics (the fifth level of the ATC classification), and, finally, to compare the antibiotic use in Republic of Srpska in relation to the antibiotic use in European Union countries. Materials and Methods. Collection and analysis of data on drug consumption is done using ATC/DDD methodology, established by the WHO. Data are taken from the report on drug consumption and distribution in the Republic of Srpska during the period from 2009 to 2014, which are based on submitted data from pharmacies registered in the Republic of Srpska. Results. Results on outpatient antibiotic consumption in the Republic of Srpska, during the period from 2009 to 2014, indicate a total decrease by 3.41 DDDs/1000 inhabitants/day, with the exception of 2010 and 2013, when the antibiotic consumption was increased. In 2014, total outpatient antibiotic consumption in the Republic of Srpska was 31.2% lower than the average consumption in the European Union. During the period from 2010 to 2014, the European Union had a significant increase in antibiotic consumption, while antibiotic consumption in the Republic of Srpska had a tendency of falling. Conclusion. Presented results show a quantitative analysis of antibiotic consumption and provide insight into the outpatient use of antibiotics in the Republic of Srpska, and can be used for further pharmacoepidemiological analysis of antibiotic consumption, which would give a better insight into the therapeutic practice, with the aim of improving the rational pharmacotherapy in the Republic of Srpska.

Outpatient Antibiotic Use in France between 2000 and 2010: after the Nationwide Campaign, It Is Time To Focus on the Elderly

Antibiotic overconsumption is the main force driving the emergence of multidrug-resistant bacterial strains. To promote better antibiotic use in France, a nationwide campaign has been run every year from October to March since 2002. In 2007, it was shown that winter outpatient antibiotic consumption had decreased by 26.5% compared to the 2000-2002 baseline period. Here, we quantified outpatient antibiotic use between 2000 and 2010 as a follow-up analysis of the nationwide campaign. Reimbursed outpatient antibiotic prescriptions were extracted from computerized French National Health Insurance databases. Entire series and age group and antibiotic class analyses were computed. Time series analyses used autoregressive moving-average models with exogenous variables and intervention functions. Two periods were considered: October to March "campaign" periods and April to September "warm" periods. Compared to the precampaign (2000-2002) baseline period, the numbers of weekly antibiotic prescriptions per 1,000 inhabitants during campaign periods decreased until winter 2006 to 2007 (-30% [95% confidence interval {CI}, -36.3 to -23.8%]; P < 0.001) and then stabilized except for individuals >60 years of age, for whom prescriptions reached the precampaign level. During the warm periods from April to September, no significant differences were estimated compared to the baseline level for the entire series, but seniors had an increasing trend that became significant as of 2005, reaching +21% (95% CI, +12.9 to +29.6%) in 2009 (P < 0.0001). These results highlight the need for a better understanding of antibiotic use by the elderly, requiring research with targeted and tailored public health actions for this population.

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.

Did Media Attention of the 2009 A(H1N1) Influenza Epidemic Increase Outpatient Antibiotic Use in France?: A Time-Series Analysis

BackgroundIn France, the 2009 A(H1N1) influenza epidemic occurred between September 2009 and January 2010. Sparking widespread controversy, it was intensely reported in the media. Despite therapeutic inefficacy, antibiotic consumption and viral respiratory infections are positively correlated, particularly in France, where antibiotic overconsumption is well-known. We first determined the period when media coverage was high, and then compared, during this period, observed outpatient antibiotic consumption to estimated outpatient antibiotic consumption “without media attention”.Materials and MethodsTo evaluate media coverage, two online databases were consulted: Factiva and Europresse. To quantify outpatient antibiotic consumption, we used data on reimbursements of outpatient systemic antibiotics from the computerized databases of the two main National Health Insurance agencies. Influenza-like syndromes data came from the French GPs Sentinelles Network. Weekly time-series of antibiotic consumption were modeled by autoregressive moving-average models with exogenous inputs and interventions. Analyses were computed for the entire series and by age group (0–5, 6–15, 16–60, and >60 years).ResultsMedia coverage was intense between April 2009 and January 2010. No effect on total outpatient antibiotic consumption was observed during the whole mediatic period. However, during the epidemic in France (September 2009-January 2010), we found an antibiotic underconsumption for the entire series, 0–5 and >60 years. Additionally, at the beginning of the pandemic, when cases were still outside France (June 2009-August 2009), we found an antibiotic overconsumption for patients >16 years.ConclusionThe early period of A(H1N1) virus circulation compared with seasonal influenza or an overdeclaration of ILS cases might explain the antibiotic underconsumption observed during the period of active A(H1N1) virus transmission in France. At the pandemic onset, when uncertainty was high, the overconsumption observed for individuals >16 years might have been caused by alarmist media reporting. Additional analyses are needed to understand the determinants of antibiotic consumption during this period.

Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption

ObjectiveResistance to antibiotics is the major cause of treatment failure of Helicobacter pylori infection. A study was conducted to assess prospectively the antibacterial resistance rates of H pylori in Europe...