Influence of population structure on the consumption of systemic antibiotics

The high level of consumption of systemic antibiotics in our country prompted a study of factors affecting the geographical variations in this consumption. Several parameters explain the uneven distribution of consumption: (a) the epidemiology of the infections, (b) population-dependent factors and (c) factors dependent on the prescribing doctor. The aim of this study was to study population-dependent parameters (type of population and age). A retrospective longitudinal study was made from antibiotic consumption data provided by International Marketing Services (IMS) between 1 January 1996 and 31 December 2000. The consumption indicator used was the number of defined daily doses per 1000 inhabitants per day (DID). Global consumption in regions under study varied by 5.7 DID: Medina del Campo (25.9 DID), Valladolid city (23.4 DID), Laguna de Duero (22.6 DID), Northern Region (22.4 DID), Southern Region (21.4 DID) and lastly Central Region (20.2 DID). The specific consumption per area showed a greater consumption of amoxicillin in the three urban areas, amoxicillin-clavulanic acid and the main macrolides in Medina del Campo, quinolones antibiotics in the Northern Region and tetracyclines and sulphonamides in Valladolid City. Significant area-dependent global consumption differences were observed with the most marked in urban areas. The differences were more marked when studying the geographical distribution of consumption of the commonly used antibiotics.     

Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016

Background Antibiotic resistance has reached an alarming rate globally especially in middle-income countries such as Lebanon. The development of antibiotic resistance is strongly linked to the increased population’s injudicious consumption of antibiotics. Objective This study aims to explore the trends of antibiotics consumption in the Lebanese community, between 2004 and 2016, to inform rational use of antibiotics. Setting The study was performed using the Intercontinental Marketing Statistics (IMS) Health Lebanon database Method This is an observational longitudinal study conducted through a review of the IMS database. The annual antibiotics consumption was determined by the Defined Daily Dose (DDD)/1000 inhabitants/day (DID). The trends of antibiotics consumption were then categorized by antibiotic class and spectrum of activity. Main outcome measure The total consumption of antibiotics in Lebanon and the classes of antibiotics used by the community. Results Total community consumption of antibiotics, measured by DDD/1000 inhabitants/day (DID), significantly increased from 18.71 in 2004 to 31.26 in 2016. Penicillin combinations, quinolones, third-generation cephalosporins, tetracyclines, and carbapenems showed significant uptrends, in contrast to first-generation cephalosporins, sulfonamides and diaminopyrimidines, and beta-lactamase resistant penicillins. Broad-spectrum antibiotics showed a marked increase in their consumption from 11.50 DID in 2004 to 22.51 DID in 2016 whereas intermediate-spectrum antibiotics had only a slight increase in their consumption from 7.18 DID in 2004 to 8.51 DID in 2016, and narrow-spectrum antibiotics had a severe decline in their consumption from 0.006 DID in 2004 to 0.0003 DID in 2016. Conclusion There is an alarming increase in antibiotics consumption in Lebanon, particularly broad-spectrum antibiotics. This should be complemented with evidence on the determinants of antibiotic consumption such as prescriber and patient-related factors and drug promotional activities to minimize antibiotics overuse.

     

Antibacterial drug prescription for outpatients: age, seasonal and pulmonary disease dependency

The goal of this study was to analyze antibacterial drug prescribing in the 1-million-plus, strictly defined population in Poland. For the 2002-2005 years, data from National Health Fund on outpatient purchasing of antibiotics in Lubuskie's Province were collected and expressed in DDD per 1-thousand inhabitants per day (DID). In the period 2002-2005 the average rate of antibiotics purchasing was 19.8 DID. During the 3-year period, at least 64.3% of the population had prescribed antibiotics. 22.7% of patients purchased 62.6% of a three-year total purchasing of antibacterial drugs in the province. A tiny 1.9% of the population purchased 10.0% of the total. From the different age-group, the study showed that special attention should be paid to two different and relatively small groups of patients - those utilizing significant percentage of the year's supply, and group of 5-9 year-old children. Seasonal variation in antibiotic prescribing was strictly linked with the age of patients. Pulmonary diseases were indentified as a factor considerably elevating antibacterial drugs purchasing frequency. A useful way to present recurring patterns in this frequency has been proposed.     

195例抗感染药物ADR相关因素分析

目的:分析常熟市第一人民医院2008年药物不良反应(ADR发生的原因与特点,了解抗感染药物ADR)发生的规律及影响因素。方法:将上报国家食品药品监督管理局ADR监察中心的195份抗感染药物ADR报告,按患者的年龄、性别与药品种类、给药途径、ADR所累及的系统/器官及主要临床表现等信息进行分析和评价。结果:18岁以下的未成年患者ADR发生率8.1%,60岁以上老年患者为0.9%。喹诺酮类药物ADR发生49例,β内酰胺类ADR发生72例,按照药物使用量(频次)计算,喹诺酮类药物ADR发生率则是β内酰胺类的数倍。静脉输注引发ADR185例,占94.87%,皮肤及其附件损害的ADR147例,占70.33%。结论:不同的疾病与给药途径差异是未成年与老年患者ADR发生率差异的重要原因之一;ADR与不同抗感染药物药物使用量(频次)有一定联系,但不呈线性关系,将某药物ADR例数在总ADR例数中的构成比等同于ADR发生率是不恰当的;静脉输注引发ADR发生率较高,皮肤及其附件损害的ADR易观察,及早全面发现ADR对其他器官/系统造成损害的方法或标准方面可能还存在缺陷。     

医院住院患者抗菌药物使用情况调查

目的 了解抗菌药物在我院住院部的使用情况.方法 统计2008～2010年度住院使用抗菌药物的种类、消耗量、消耗金额、用药频度(DDDs)等并进行统计分析.结果 本院使用的抗菌药物共9大类132个品种,抗菌药物年均消耗金额占住院全部药品消耗总金额的24.9%.头孢菌素类消耗金额最大,占抗菌药物总金额的66.8%,其次为青霉素类,占14.2%,喹诺酮类占11.0%.头孢曲松钠消耗金额、DDDs均居首位,喹诺酮类和青霉素类在临床上也占相当大的比例.结论 抗菌谱广、耐酶性强、毒性低、安全性高的第3代头孢菌素类占本院抗菌药物的首位.     

濮阳市油田总医院门诊抗菌药物应用分析

目的：了解我院门诊抗菌药物使用情况,并按卫生部标准时其合理性进行评价,为临床用药提供参考。方法：逐月抽查2011年我院门诊处方共13888张,统计抗菌药物的使用情况,并对其使用合理性进行评价。结果：2011年我院累计抽查13888张门诊处方,使用抗茵药物的处方有3222张,抗菌药物使用率为23．20％。使用的抗菌药物共9大类39个品种66个规格,主要以头孢菌素类为主,其次为大环内酯类和氟喹诺酮类。销售金额排序前10位抗菌药物的销售金额为404．78万元．占抗菌药物总销售金额的65．94％（404．78／613．82）。不合理使用抗菌药物处方有237张,占使用抗茵药物处方的7．36％（237／3222）,占不合理用药处方总数的63．88％（237／371）。结论：我院门诊处方抗菌药物使用基本合理,但也存在抗菌药物选用较为集中、起点较高等问题,应继续加强用药监管。     

Antibiotic policies in Central Eastern Europe

To assess the antibiotic policies in Central Eastern European (CEE) countries, a questionnaire on the prevalence of resistance, antibiotic consumption data for ambulatory and hospital care and antibiotic policies, was mailed to national representatives. Data on antibiotic resistance and consumption of antibiotics at national levels are limited and vary considerably among countries. The importance of surveillance data in altering perceptions of the prevalence of resistance is shown by the comparison of surveillance data and interview data. Interview data without surveillance data produced the widest range of estimates of the prevalence of resistance in streptococcus pneumonia -5% in Lithuania and 82% in Belarus. The average consumption of antibiotics in ambulatory care in eight CEE countries in 2001 was 19.35 defined daily doses (DDD)/1000 inhabitants per day, (range 13.1 - 24.8 DDD) and in hospitals in six CEE countries was 2.2 DDD/1000 inhabitants per day (range 1.3-4.5). Over the counter sales of antibiotics are available in some countries. Antibiotic policy interventions do not exist or only apply to specific problems or interventions. Better implementation of antibiotic interventions and education on antibiotic use should be a high priority in this region. An effective strategy requires close co-operation, consultations and partnership at national and international level in particular, via existing international organisations.     

Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study

The ECO.SENS study investigated the prevalence and antimicrobial susceptibility of pathogens causing community-acquired acute uncomplicated urinary tract infections (UTIs) in 4734 women aged 18-65 years presenting with symptoms of acute UTI, at 252 community healthcare centres in 16 countries in Europe plus Canada. Resistance in Escherichia coli occurred most frequently to ampicillin (30%) and sulphonamides (29%), followed by trimethoprim (15%), trimethoprim/sulphamethoxazole (14%) and nalidixic acid (5%) but was low to co-amoxiclav, mecillinam, cefadroxil, nitrofurantoin, fosfomycin, gentamicin and ciprofloxacin, all at<3%. Consumption of antibiotics in 1997 varied more than 4-fold within Europe and from 9 to 37 DDD/1000 inhabitants/day, the consumption being highest in Southern Europe. The consumption of broad-spectrum penicillins correlated with resistance to ampicillin and there was a clear correlation between quinolone consumption and resistance to ciprofloxacin and nalidixic acid. The 4-fold difference in antibiotic consumption within Europe and the correlation to resistance emphasises the importance of controlling antibiotic usage.     

呼吸内科住院患者抗菌药物应用分析

目的：了解呼吸内科住院患者抗菌药物的使用情况,为加强合理应用与管理抗菌药物提供依据。方法：以随机抽样法抽取2010年呼吸内科使用抗菌药物归档住院病历243份,采取逐份检查并记录存在的问题,通过Excel表进行汇总统计分析。结果：243份病历,抗菌药物静脉用药共计12大类30个品种;口服用药共计6大类14个品种。其中单一用药22例,占9.05%;二联用药212例,占87.24%;三联用药9例,占3.70%。结论：抗菌药物在呼吸内科住院患者中的使用基本合理,但也存在一些问题需要改进和加强管理。     

ESBLs阳性菌株的耐药性及抗菌药物消耗量相关性研究

目的：探讨ESBLs阳性菌株的耐药性与抗菌药物消耗量相关性。方法：对我院86例ESBLs阳性菌株的抗感染用药进行全程观察,根据药敏试验结果、用药频度、用药品种、用药天数,分别进行耐药性和相关药物消耗量统计分析。比较耐药率与消耗量。结果：ESBLs阳性菌株对第3代头孢菌素、氟喹诺酮类耐药率达85%以上,对碳青霉烯类敏感,对β-内酰胺类抗生素加酶抑制药的复合制剂较敏感。但敏感度有下降趋势。回归分析表明ESBLs阳性菌株的耐药性与相关抗菌药物消耗量有显著相关意义。结论：ESBLs阳性菌株的耐药性与相关抗菌药物消耗量显著相关。     

Age standardisation of drug utilisation: comparisons of different methods using cardiovascular drug data from Sweden and Spain

In drug utilisation studies, the units of defined daily doses (DDD) and DDD/1000 inhabitants per day standardise for differences in dosage and population size, but not for age-related differences in drug utilisation. There is no consensus as to how age standardisation of DDD data should be carried out. Using cardiovascular drug utilisation data from Sweden and Spain, the current study compared the outcome of different methods of age standardisation. Both indirect methods (based on a comparison of observed and expected drug usage) and direct methods (using different weighting for the age categories) were used.The largest impact of standardisation was seen for diuretics. The crude rate for men and women combined was 26 DDD/1000 inhabitants per day in Costa de Ponent and 98 DDD/1000 inhabitants per day in Värmland. The corresponding figures when standardising the Costa de Ponent population were 26 and 58, respectively. Using the equivalent average rate (EAR) method, the rate for Värmland was 129 DDD/1000 inhabitants per day. Lesser but still important differences were found for -adrenoceptor and antihypertensives.Thus, the results of standardisation differ depending on which method is used and which drugs are evaluated. EAR is recommended for direct standardisation because of its ease of use and because it does not require the choice of a standard population.     

2005～2008年口腔医院门诊抗菌药物应用分析

目的：了解口腔医院门诊抗菌药物的使用情况,为加强抗菌药物的科学管理和合理应用提供依据。方法：采用金额排序和用药频度法,对2005～2008年北京大学口腔医院门诊抗菌药物的应用情况进行统计分析。结果：抗菌药物金额逐年增加,占总用药金额的比例（15.63%～17.74%）逐年下降,口服给药约占90%。各亚类用药金额、DDDs的排序变化不大,抗真菌药、青霉素类、头孢菌素类和大环内酯类用药金额位于前4位,抗真菌药、硝基咪唑类、头孢菌素类和青霉素类用药频度每年均位于前4位。结论：抗菌药物使用基本合理,但仍需进一步提高合理用药水平,并应鼓励开发适于口腔疾病患者的局部给药剂型。     

2007—2008年上海地区二、三级医院抗菌药物应用分析

目的：了解上海地区二、三级医院抗菌药物应用情况。方法：调查上海市12家二级医院和14家三级医院2007—2008年抗菌药物的处方张数、用药金额、用药频度等信息,并进行统计分析。结果：二级医院抗菌药物用药金额占总用药金额比高于三级医院;二、三级医院抗菌药物用药金额、处方张数和均次费用均有不同程度的增长,且在各管理类别抗菌药物使用上存在差异;第2代头孢菌素、氟喹诺酮类、第3代头孢菌素均居二、三级医院用药金额排序前3位;用药金额排序前10位的抗菌药物品种中,二、三级医院均以头孢替安和头孢西丁增幅最大;二、三级医院抗菌药物DDDs排序前10位的品种大多数相同。结论：二、三级医院在抗菌药物使用中存在部分差异,应加强抗菌药物临床合理使用。     

Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions

AIMS: Cutaneous manifestations are frequently reported in association with drug use. The aim of this study was to analyse the skin reactions reported to the spontaneous surveillance systems of four Italian regions (Friuli Venezia Giulia, Lombardy, Sicily and the Veneto), and correlate the reports with estimated drug consumption during the same period, paying particular attention to the reactions to antimicrobial agents and nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: All of the adverse drug reactions (ADRs) reported spontaneously between January 1996 and December 1997 to the surveillance systems of four Italian regions (a total population of about 20 million people) were analysed by a panel of experts including dermatologists. On the basis of the Critical Term List of the World Health Organization (WHO), the reactions were classified as either serious or nonserious events. Drug consumption was expressed as a daily defined dose (DDD)/1000 inhabitants/day. RESULTS: A total of 2224 adverse skin reaction reports (44.7% of all of the reported ADRs) were identified, making a reporting rate of about 5.5 per 100 000 inhabitants/year. The female/male ratio was 1.58, and the reporting rate progressively increased with age. The drug categories with the highest number of cutaneous reactions were antimicrobials, followed by NSAIDs, analgesics and radiology contrast media. There was a total of 372 (16.9%) serious reaction reports, the most frequent being angioedema (171 cases), erythema multiforme (68 cases) and photosensitivity (37 cases). Co-trimoxazole, followed by the cephalosporins and fluoroquinolones, were associated with the highest consumption-related reporting rate among the antimicrobials, and aspirin and dipyrone among the NSAIDs and analgesics. CONCLUSIONS: Spontaneous reports from four Italian regions revealed that the skin was the organ most frequently affected by ADRs. The paper shows the validity of a regional decentralized system in Italy.     

2007～2008年我院住院患者抗菌药物应用分析

目的：评价2007～2008年我院住院患者抗菌药物临床应用情况,为临床合理用药提供依据。方法：对2007～2008年我院住院病房抗菌药物的品种数、用药金额、用药频度（DDDs）等进行统计分析。结果：2007～2008年我院住院药房抗菌药物品种数以及抗菌药物销售金额占全年西药销售金额的构成比变化不大。头孢菌素类和β-内酰胺酶抑制剂复合制剂销售金额在各年均排在前2位,头孢呋辛和司帕沙星的DDDs在各年均排在前2位,在＂特殊使用＂抗菌药物中头孢吡肟的使用频率最高。结论：我院住院患者抗菌药物使用基本合理,但要进一步加强＂特殊使用＂抗菌药物的管理。