Enfermedades Infecciosas y Microbiología Clínica
Original articleDifferences 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
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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