Analysis of the causes and consequences of decreased antibiotic consumption over the last 5 years in Slovenia

• Published in: Journal of antimicrobial chemotherapy Vol. 55; no. 5; pp. 758 - 763
• Main Authors: Čižman, M., Srovin, T., Pokorn, M., Čad Pečar, S., Battelino, S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2005; Oxford Publishing Limited (England)
• Subjects: Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination - therapeutic use; Anti-Bacterial Agents - therapeutic use; antibiotic prescribing; Antibiotics. Antiinfectious agents. Antiparasitic agents; bacterial resistance; Biological and medical sciences; Drug Resistance, Bacterial; Drug Utilization - statistics & numerical data; Fluoroquinolones - therapeutic use; interventions; Mastoiditis - epidemiology; Medical sciences; Penicillin Resistance; Pharmacology. Drug treatments; Pneumococcal Infections - epidemiology; Pneumococcal Infections - microbiology; Retrospective Studies; Slovenia - epidemiology; Streptococcus pneumoniae - drug effects; Europe; Slovenia; Infection; Resistance; Antibiotic; interventions; Medical prescription; antibiotic prescribing; bacterial resistance; Bacteriosis; Bacteria; Antibacterial agent
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dki098

Objectives: Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999–2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences. Methods: The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on ‘antibiotic drugs’ and ‘bacterial resistance’ during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained. Results: The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=−0.73 for the C-reactive protein test and −0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption. Conclusion: Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.