The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications - PubMed (original) (raw)

Observational Study

The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications

Jurij Fürst et al. Expert Rev Anti Infect Ther. 2015 Feb.

Abstract

Introduction: Rising antibiotic resistance has become an increasing public health problem. There is a well-established correlation between antibiotic consumption and antimicrobial resistance. Consequently, measures to rationalize the prescribing of antibiotics should reduce the resistant strains. Following a 24% increase in antibiotic consumption at the end of the 1990s, multiple activities were designed and introduced by the Health Insurance Institute of Slovenia (ZZZS) and other organizations in Slovenia at the end of 1999. These activities reduced the antibiotic consumption by 18.7% by 2002. These measures have continued.

Objective: To study changes in antibiotic utilization from 1995 to 2012 alongside the multiple interventions and their consequences, including changes in resistance patterns.

Methods: This was a retrospective observational study involving all patients dispensed at least one ZZZS prescription for an antibiotic in Slovenia. Utilization was expressed in defined daily doses per thousand inhabitants per day. Multifaceted interventions were conducted over time involving all key stakeholder groups, that is, the Ministry of Health, ZZZS, physician groups and patients. These included comprehensive communication programs as well as prescribing restrictions for a number of antibiotics and classes.

Results: From 1999 to 2012, antibiotic consumption decreased by 2-9% per year, with an overall decrease of 31%. There were also appreciable structural changes. Overall antibiotic utilization and the utilization of 7 out of 10 antibiotics significantly decreased after multiple interventions. The resistance of Streptococcus pneumoniae to penicillin decreased in line with decreased utilization. However, its resistance to macrolides increased from 5.4 to 21% despite halving of its utilization. The resistance of Escherichia coli to fluoroquinolones doubled from 10 to 21% despite utilization decreasing by a third. Expenditures on antibiotics decreased by 53%.

Conclusion: Multiple demand-side measures introduced following increased utilization significantly decreased subsequent antibiotic utilization and associated costs. However, there was variable impact on antibiotic resistance. Additional targeted activities are planned to further reduce antibiotic prescribing and resistance.

Keywords: Slovenia; antibiotic resistance; antibiotic use; drug utilization; multifaceted interventions; policies; rational use of antibiotics.

PubMed Disclaimer

Cited by

Trends in paediatric macrolide use in five European countries-a population-based study.
Holstiege J, Enders D, Schink T, Innocenti F, Oteri A, Bezemer I, Kaguelidou F, Molokhia M, Poluzzi E, Puccini A, Ulrichsen SP, Sturkenboom MC, Trifirò G, Garbe E. Holstiege J, et al. Eur J Clin Pharmacol. 2015 Aug;71(8):991-9. doi: 10.1007/s00228-015-1870-7. Epub 2015 May 22. Eur J Clin Pharmacol. 2015. PMID: 25998220
Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat.
Jakovljevic M, Al Ahdab S, Jurisevic M, Mouselli S. Jakovljevic M, et al. Front Public Health. 2018 Aug 2;6:212. doi: 10.3389/fpubh.2018.00212. eCollection 2018. Front Public Health. 2018. PMID: 30116726 Free PMC article.
Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis.
Fernández-Urrusuno R, Meseguer Barros CM, Benavente Cantalejo RS, Hevia E, Serrano Martino C, Irastorza Aldasoro A, Limón Mora J, López Navas A, Pascual de la Pisa B. Fernández-Urrusuno R, et al. PLoS One. 2020 May 15;15(5):e0233062. doi: 10.1371/journal.pone.0233062. eCollection 2020. PLoS One. 2020. PMID: 32413054 Free PMC article.
Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: analysis of 42 interventions targeting E. coli.
Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson CA, Majowicz SE, Troell M, Parmley EJ, Jørgensen PS, Wernli D. Léger A, et al. BMC Infect Dis. 2021 Aug 26;21(1):873. doi: 10.1186/s12879-021-06483-z. BMC Infect Dis. 2021. PMID: 34445962 Free PMC article.
Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries.
Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Godman B, et al. Life (Basel). 2021 Jun 7;11(6):528. doi: 10.3390/life11060528. Life (Basel). 2021. PMID: 34200116 Free PMC article. Review.

The influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications - PubMed (original) (raw)