Quantitative analysis of the consumption of antibacterials prescribed in the ambulatory care and reimbursed by HII in Albania during 2011-2012 (original) (raw)
Point Prevalence Survey of Antibiotic Prescribing in the Hospital Sector in Albania
Acta Pharmaceutica Sciencia, 2021
Antibiotic resistance represents a serious threat worldwide. The onset and spread of resistance is mostly related to irrational and increased use of antibiotics. The aim of this study was to evaluate antibiotic prescribing patterns and identify areas for quality improvement in the hospital sector in Albania. A Point Prevalence Survey study was conducted, at a University Hospital Centre in Tirana, Albania. On the day of the survey, 65.7% of the inpatients were on antibiotic treatment, mostly for medical prophylaxis (67.1%). The higher prevalence was found in Intensive Care Units (81.0%). The most commonly used antibiotics were the cephalosporins (53.1%) followed by metronidazole (16.2%) and fluoroquinolones (14.7%). High rates of antibiotic use were found in all wards, while some indicators related to prescribing patterns were critical. A close and continuous surveillance of the antibiotic use, along with measures at national level could contribute in improving a proper use of antibiotics.
Antibiotics
There are growing concerns with rising antimicrobial resistance (AMR) across countries. These concerns are enhanced by the increasing and inappropriate utilization of ‘Watch’ antibiotics with their greater resistance potential, AMR is further exacerbated by the increasing use of antibiotics to treat patients with COVID-19 despite little evidence of bacterial infections. Currently, little is known about antibiotic utilization patterns in Albania in recent years, including the pandemic years, the influence of an ageing population, as well as increasing GDP and greater healthcare governance. Consequently, total utilization patterns in the country were tracked from 2011 to 2021 alongside key indicators. Key indicators included total utilization as well as changes in the use of ‘Watch’ antibiotics. Antibiotic consumption fell from 27.4 DIDs (defined daily doses per 1000 inhabitants per day) in 2011 to 18.8 DIDs in 2019, which was assisted by an ageing population and improved infrastructu...
Hippokratia
Self-medication is defined as the utilization of drugs to treat self-diagnosed disorders or symptoms, or the irregular or continuous use of a prescribed drug for chronic or repeated diseases or symptoms. The main problem with self-medication with antimicrobials is the emergence of pathogenic resistance. Antimicrobial resistance is an existing problem world-wide, mainly in developing countries. The aims and objectives of the study presented in this article are to evaluate the prevalence of purchase of antibiotics without prescription and appropriateness of use among adults and to determine the impact of the education level on the sensibility level over the use of antibiotics. This was a questionnaire based study of 3 month duration. The study includes data from 350 young adults (182 men/172 women, mean age ± SD: 34.72 ± 13.7 years), who visited ten different pharmacies located in the city of Tirana and the "Olympus" Private Medical Clinic in Fier between December 2012 and M...
The Journal of Infection in Developing Countries
Introduction: Healthcare-associated infections (HAIs) and irrational use of antibiotics in healthcare settings are major global public health concerns. Surveillance of HAIs in intensive care units (ICU), surgical-site infections (SSIs), and Clostridium difficile infections (CDIs), together with implementation of antibiotic stewardship, are cornerstones of hospital infection prevention programs. The aim of this study was to evaluate antibiotic consumption, especially of broad spectrum antibiotics, in relation to HAI incidence density (ID). Methodology: The study was conducted from 2011 to 2016 in a tertiary hospital, the Military Medical Academy (MMA), in Belgrade, Serbia. Through regular hospital surveillance we identified all patients with a new HAI. Data on consumption of antibacterials for systemic use were expressed as defined daily dose per 100 bed days (DDD/100 BD). Results: The highest incidence density (ID) of HAI was observed among patients in surgical ICUs (47.2 per 1000 p...
Slovenian Journal of Public Health
Aim The 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 con...
Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study
Journal of Chemotherapy, 2016
Background: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana. Methods: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units. Results: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community-and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples. Conclusion: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.
Increase and Change in the Pattern of Antibiotic Use in Serbia (2010–2019)
Antibiotics, 2021
The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.
Point prevalence survey on antibiotic use in a Croatian Infectious Disease Hospital
Journal of Chemotherapy, 2013
Antibiotic use is the driving force for increasing antibiotic resistance. A large proportion of antibiotics in hospitals are used inadequately. The objective of this study was to evaluate antibiotic use at the Hospital for Infectious Diseases through point-prevalence surveys conducted in 2006, 2008 and 2009. Point prevalence surveys were part of the European Surveillance on Antimicrobial Consumption (ESAC) Hospital Care Subproject and patients` data were collected following ESAC protocol. Additionally, the adequacy of antimicrobial therapy and Point-prevalence surveys proved to be a valuable method for detecting targets for antibiotic prescribing improvement and they clearly showed that our local hospital guidelines offered too many choices of antibiotic treatment for each clinical indication and needed revision.
Patterns of Antibiotic Prescription in Children: Tirana, Albania Region
Open Access Macedonian Journal of Medical Sciences, 2018
BACKGROUND: Antibiotics (abx) constitute the most prescribed therapeutic agent in the world. There is little data regarding antibiotic consumption by young children in Albania.AIM: This study aims to evaluate antibiotic prescription in children in quantitative and qualitative terms, and therefore, propose recommendations to improve overall clinical outcomes.METHODS: A retrospective, cross-sectional drug utilisation study was conducted based on unreimbursed prescriptions collected in 25 pharmacies, randomly selected within the district of Tirana, during the period beginning December 2015 to January 2016. They contain at least one antibacterial therapeutic agent prescribed for children 0-15 years old, for systemic use. The data were analysed using SPSS 20.RESULTS: A group of 904 prescriptions meet inclusion criteria, 54.1% patient were female, and 45.9% were male. The most exposed age group were 2-6 years old. The most common diagnosis was respiratory tract infections: bronchitis (59....
Journal of Antimicrobial Chemotherapy, 2009
Objectives: Antibacterial consumption is increasing in many countries around the world, and it is increasingly recognized as the main reason for the emergence of resistance. This study was implemented to analyse antibacterial consumption in public hospitals in Denmark during 2001-07 as a follow-up on a prior analysis and furthermore, to investigate the consequences of the occurrence of resistance. Methods: National data on the consumption of antibacterials for systemic use in Danish public hospitals were obtained from 2001 through 2007. Consumption data were compared with antimicrobial resistance in all isolates recorded from either blood samples (Escherichia coli and Klebsiella pneumoniae) or urine samples (E. coli) submitted for susceptibility testing to the participating Departments of Clinical Microbiology during 2001-07. The consumption of combinations of penicillins including b-lactamase inhibitors, cephalosporins, carbapenems and fluoroquinolones continued to increase from 19.2% of the total consumption in hospitals in Denmark in 2001 to 38.2% in 2007. Quinolone resistance in E. coli isolates from blood and urine samples increased significantly from 2001 through 2007. Furthermore, multiresistant K. pneumoniae emerged. The consumption of 'broad-spectrum' antibacterial agents has continued to increase in Danish hospitals. At the same time, an increasing resistance in clinical isolates towards the same antibacterial agents has been observed. However, more detailed information on the specific consumption of the antibacterial agents might help to restrict or reverse the increasing use of 'broad-spectrum' antibacterial agents and perhaps also the increasing antimicrobial resistance.
Croatian Medical Journal, 2010
Aim To investigate antibiotic consumption in a sample of physicians from Osijek-Baranja county in Eastern Croatia and to determine the volume of prescribed antimicrobials and assess the appropriateness of prescribing practices. Methods Analysis of routine prescribing data was carried out in 30 primary care practices in both urban and rural communities of eastern Croatia, corresponding to a total population of 48 000 patients. Prescribing practices were studied over a period of 3 years, from 2003 to 2005. Both the quantity of antimicrobials and differences and similarities between individual practitioners were analyzed. Results Urban and rural practices did not significantly differ in regard to the volume of antimicrobials prescribed. However, significant differences were found between individual physicians. Total consumption was 17.73 defined daily doses per 1000 inhabitants per day or 6456.85 defined daily doses per 1000 inhabitants per year. The 10 most frequently used antimicrobials (93.70% of the total quantity) were amoxicillin, co-amoxiclav, co-trimoxazole, cephalexin, norfloxacin, penicillin V, azithromycin, cefuroxime, doxycycline, and nitrofurantoin. Sore throat was the most frequent reason for prescribing antibiotics. Conclusion Prescription of medicines in Osijek-Baranja county was characterized by high consumption of broadspectrum penicillins, combined penicillins, combined sulfonamides and long-acting macrolides (azithromycin), together with disproportionately low use of doxycycline and erythromycin. The use of combined sulfonamides and azithromycin in this part of Croatia was among the highest in Europe. Great differences between prescribers in regard to indication-based prescribing have been found, and future studies should examine the factors behind these heterogeneous practices.
Analysis of non-hospital antibacterial pharmacotherapy in Poland
International Journal of Infectious Diseases, 2008
Objectives: The aim of this research was to analyze the antibacterial drug consumption pattern in a 1-million-plus strictly defined population in Poland. We assessed outpatient antibiotic sales (ATC J01) in relation to patient age and season of the year, and sought to determine the group of patients with the most frequent recurrence of bacterial diseases. Methods: The Lubuskie Regional Unit of the National Health Fund (NHF) and the Central Statistical Office (GUS) were the main sources of data. For the period 2002-2005, data on outpatient sales of antibiotics (ATC J01) in Lubuskie Province were collected and expressed in DDD (defined daily dose; World Health Organization anatomical therapeutic chemical (ATC)/DDD version 2006) per 1000 inhabitants per day (DID). Results: During the period 2002-2005, the average level of antibiotic use amounted to 19.8 DID in the Lubuskie population. During the 3-year period, 64.3% of the population was treated with antibiotics. This value varied for different age groups. Of the patients, 22.7% utilized 62.6% of a 3year supply of antibiotic therapy in the province; a small 1.9% of the population used 10.0% of the supply. The seasonal variation of antibiotic consumption in different age groups showed a strong tendency to be flatter as the older age groups were analyzed. Conclusions: The data gained from the payers, i.e., the healthcare system, is a very valuable source of information for pharmacoepidemiological studies. Our study shows that seasonal variation in antibiotic use is strictly linked with the age of patients. Special attention should be paid to the relatively small group of patients that utilizes a significant percentage of the year's supply. We have established an effective way to present recurrence data (a map showing the infectious disease incidence). This could be a very useful tool for comparing antibiotic consumption in different countries. #
Journal of Applied Pharmaceutical Science, 2018
The use and misuse of antimicrobial agents need to be evaluated since misuse of antimicrobials may lead to increased adverse effects, resistance to antimicrobials, making illnesses more serious, and increasing expenses of health services. The aim of this study was to assess the pattern of antimicrobial prescriptions at a tertiary hospital. This prospective, observational study was conducted at a tertiary hospital after obtaining ethical committee clearance. On a daily basis, data were collected from inpatient case sheets. In addition, some data were obtained from the pharmacy department. According to World Health Organization guidelines, specified indicators were applied and the collected data were analyzed using descriptive statistics parameters. During the study period, 900 patient case sheets were included in the study and it was seen that 255 patients were prescribed antimicrobial agents. It was found that antibiotics were the most common type of antimicrobials prescribed. The average duration of prescribed antimicrobial treatment for each subject was 5.65 days and the average cost of antimicrobials prescribed per patient was 9422 INR (140 USD). It was observed that only for 10.58% of patients who were prescribed with antimicrobial agents, culture sensitivity test was performed. The use of antimicrobials in our study site was found to be less than optimal. Hence, there is a need to promote rational use of antimicrobials, as their irrational use would lead to antimicrobial resistance.
Antibiotic Use in Slovenian Hospitals
International Journal of Research -GRANTHAALAYAH
Motivation/Background: Antibiotics are commonly overused and misused what increase the emergence of resistant organisms, side-effects and costs. To assess the appropriate use of antibiotics many methods are available. The aim of the present study is to find correlation between antibiotic use and case mix index (CMI) in Slovenian hospitals. Method: In retrospective study (in the years between 2004 and 2013) we correlated the total consumption of antibiotics for systemic use and CMI. Weighted linear regression test analysis was performed to determine correlation between defined daily dose (DDD) / 100 admissions and DDD / 100 bed-days and CMI. Results: The total antibiotic consumption in all included hospitals was in mean 317.69 DDD / 100 admissions and 58.88 DDD / 100 bed days, respectively. CMI range were from 1.25 to 3.55. A significant correlation between consumption expressed in DDD / 100 admissions and CMI (p = 0.028) and DDD / 100 bed days and CMI (p =0.008) was found. Conclusions: Thus, detailed analysis of correlations between DDD of antibiotics and CMI may constitutes a proper use of antibiotics.
Antibiotics, 2021
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 tota...
Antimicrobial consumption at a university hospital in Turkey
African Journal of Microbiology Research, 2012
Excessive antibiotic use is a challenging topic because of the total annual expenditure and the high resistance against antimicrobials in Turkey. A point-prevalence study was performed to evaluate the daily antibiotic consumption and the cost. Data were collected by infectious diseases consultants on 30 January, 2009 and 28 January 2010. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate antibiotic consumption. On a specific day in 2009, 191 of 418 patients (45.6%) received antibiotics and on the specific day in 2010, 167 of 316 patients (52.8%) received antibiotics as well. With respect to the years antimicrobials were given empirically (41.9 and 38.3%, respectively). The percentage of antibiotics used appropriately was 70.2 and 71.3%, in 2009 and 2010 respectively. The mean total antibiotic consumption was 64.5 DDD/100 bed-days in 2009 and 70.46 DDD/100 bed-days in 2010. The most frequently used substance class was cephalosporins (16.75 and 24.14 DDD/100 bed-days, respectively). The cost of all used antibacterials during the study period in 2009 was 5,713.7 € for all patients (29.9 € per infected patient). In the study period of 2010, the total cost was 4,240.13 € (25.39 € per infected patient). The cost of all used antimycotics for the combined study periods of 2009 and 2010 was 623.74 and 920.62 €, respectively. Hospitals should follow and evaluate their antibiotics use as DDDs so they could compare their antibiotics use with hospitals from other countries.