Original article
Differences in outpatient antibiotic use between a Spanish region and a Nordic countryDiferencias en el uso extrahospitalario de antibióticos entre una región española y un país nórdico

https://doi.org/10.1016/j.eimc.2013.10.002Get rights and content

Abstract

Introduction

Antibiotic use and misuse are linked to pathogen resistance and, as such, both constitute a public health issue with local, national, and global dimensions. Early studies have shown striking variations in the use of these drugs between Nordic and Mediterranean countries. The aim of the present study was to describe and compare antibiotic prescribing in Primary Care in Denmark and Aragón (a North-eastern Spanish region).

Methods

Outpatient antibiotic prescription data (2010) were obtained from the National Institute for Health Data and Disease Control (Denmark), and the Information System on Medication Consumption in Aragón. The consumption of antibiotics (ATC J01) was analyzed from the prescription rates and the number of defined daily dose (DDD) per 1000 inhabitants/day (DID).

Results

The rate of antibiotic prescription in 2010 in Aragón was greater than in Denmark (407 compared to 315 exposed individuals/1000 inhabitants). There were significant differences as regards overall consumption of antibiotics (23.2 DID in Aragón and 17.0 DID in Denmark), as well as the therapeutic group selection. There was an elevated use of broad spectrum penicillins, quinolones and cephalosporins in the Spanish region while, in Denmark, the most-consumed antibiotic was narrow spectrum penicillin.

Conclusion

The use of antibiotics in the Spanish region is very high, and there are marked differences in the choice of drug between this region and Denmark. Interventions are needed that promote the rational use of these drugs to reduce potential bacterial resistance, and to avoid unnecessary risks to patients.

Resumen

Introducción

El uso inadecuado de antibióticos se ha relacionado con la aparición de resistencias microbianas, constituyendo así un problema de salud pública de dimensiones locales, nacionales y globales. Estudios previos han mostrado importantes diferencias en el uso de estos fármacos entre los países nórdicos y los mediterráneos. El objetivo de este estudio fue describir y comparar la prescripción antibiótica en atención primaria en Dinamarca y Aragón.

Métodos

Los datos de utilización extrahospitalaria de antibióticos (2010) se obtuvieron del National Institute for Health Data and Disease Control (Dinamarca) y del Sistema de Información de Consumo Farmacéutico de Aragón. El consumo de antibióticos (ATC J01) se analizó mediante las tasas de prescripción y el número de dosis diaria definida por 1.000 habitantes/día (DHD).

Resultados

La tasa de prescripción antibiótica en 2010 en Aragón fue superior a la de Dinamarca (407 frente a 315 expuestos/1.000 habitantes). Se observaron diferencias significativas en cuanto al consumo total de antibióticos (23,2 DHD en Aragón y 17 DHD en Dinamarca), así como en la elección del grupo terapéutico. La utilización de penicilinas de amplio espectro, quinolonas y cefalosporinas en la región española fue elevada, mientras que en Dinamarca el antibiótico más consumido fue una penicilina de espectro reducido.

Conclusión

El uso de antibióticos en Aragón es elevado, y existen importantes diferencias en la elección del tipo de fármaco entre esta región y Dinamarca. Sería conveniente desarrollar intervenciones que promuevan el uso racional de estos fármacos, para reducir las resistencias bacterianas y evitar riesgos innecesarios a los pacientes.

Introduction

Antimicrobial resistance threatens the effectiveness of successful treatment of infections. It is becoming a public health issue with local, national, and global dimensions. The outcomes are the increased morbidity, disease burden, and mortality.1 Several studies have shown the relationship between antimicrobial drug use and the level of pathogen resistance at a national level in countries within the European Union. Antibiotic overuse and misuse have been recognised as important factors determining the development of antimicrobial resistance.2

Early studies showed striking geographical variations in the use of antibiotics between the Nordic and the southern European countries. Denmark had a low consumption, and the prescribing profile followed national guidelines. Conversely, Spain was one of the countries where antibiotics were most often used.2, 3 However, and according to recent data, changes have been occurring. Antimicrobial drug consumption in the Danish Primary Health Care has increased notably during the latest decade.3, 4 In Spain, not only at the national level but also regional, there have been several campaigns and interventions conducted in favour of a more rational, and prudent, use of antibiotics.5 These messages directed at physicians, drug companies, and patients may have had positive influence on the observed decrease in antibiotic use.5

Awareness of outpatient antibiotic use and their regional differences are important tools for action and investigation, and should be a stimulus to improve the quality of prescription and, hopefully as a result, to reduce resistance levels.3

The aim of the present study was to describe and compare antibiotic prescribing in Primary Care in Denmark and Aragón (an Autonomous Region in north-eastern Spain).

Section snippets

Methods

The data on consumption of antibiotics in Primary Care in the year 2010 were obtained from the National Institute for Health Data and Disease Control in Denmark6 and the Information System for Medication Consumption in the Aragón Community. The Danish database is a public, open-access web that contains the following information: identification of the dispensed product according to the Anatomical Therapeutic Chemical (ATC) classification code defined by the World Health Organization (WHO),

Results

The antibiotic prescription rate in Denmark in 2010 was 315 per 1000 inhabitants per year (95% CI: 311–320) compared to that in Aragón, 407 per 1000 inhabitants per year (95% CI: 396–418). When adjusted for age, these rates were 311 in Denmark and 409 per 1000 inhabitants per year in Aragón. The prescription rate was higher in Aragón for all ages, except for those above 80 years of age where the prescription rate was higher in Denmark. The differences between the two study regions were

Discussion

The present study provides relevant data on the use of antibiotics in Denmark and Aragón (Spain). In the past decade, Vaccheri et al.9 compared the prescription of antibiotics in Ravenna (Italy) with that in Funen (Denmark). The rate of prescription in the Italian region was higher than in the Danish region (400 inhabitants exposed versus 300/1000 inhabitants, respectively). Our results reflect a prescription rate in Aragón (407 exposed/1000 inhabitants) that is similar to the Italian

Funding

S. Malo was supported by a grant from the Programa Europa XXI, funded by the DGA (CONAID) and the Inmaculada Savings Bank [Grant number CM 8/12 to S.M].

The work received external funding from the Proyecto del Fondo de Investigación Sanitaria (Instituto de Salud Carlos III, Spanish Ministry of Science, Grant PI10/01048).

Conflict of interest

The authors have no conflict of interest to declare.

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