engleski

Outpatient antibiotic utilisation in the city of Zagreb in 2005.

Objective: To analyze antiobiotic utilization in Croatia using Anatomical-Therapeutic-Chemical (ATC) drug classification system and number of defined daily doses (DDD). Methods: Data on the number of packages and purchase price were collected for each individual drug. These data were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID). Data obtained from 80% of pharmacies and 65% of hospitals were extrapolated to the total number of pharmacies and hospitals in Croatia. Drug utilization 90% (DU90%) segment was used as a prescribing quality indicator. Results: In 2005, the overall utilization of antibiotics in Croatia amounted to 23.35 DDD/TID. According to drug groups, penicillins (J01C) showed highest utilization (12.24 DDD/TID), predominated by the subgroup of penicillin combinations (including beta-lactamase inhibitors, J01CR) with 6.86 DDD/TID, within which the combination of amoxicillin + clavulanic acid accounted for 99.9% with 6.85 DDD/TID. Broad-spectrum penicillins (J01CA) accounted for 43.2% (5.28 DDD/TID) of total penicillin utilization, with a 97.7% predominance of amoxicillin (5.16 DDD/TID). Cephalosporins (J01D) ranked second with 4.00 DDD/TID, followed by macrolides and lincosamides (J01F) with 2.41 DDD/TID, with an 86.84% predominance of macrolides (J01FA) with 2.09 DDD/TID. Among the latter, azithromycin showed highest utilization with 1.44 DDD/TID, accounting for 68.66% of total macrolide utilization. Tetracyclines (J01A) ranked fourth with 2.02 DDD/TID, accounting for 8.65% of overall antibiotic utilization, followed by quinolones with 1.65 DDD/TID, other antimicrobials with 0.91 DDD/TID, and aminoglycosides with 0.16 DDD/TID. Sulfonamides (J01E) accounted for a negligible proportion of overall utilization. DU90% segment included 9 of 43 antibiotics registered in Croatia, with amoxicillin + clavulanic acid as the leading one, followed by cephalexin with 1.83, cefuroxime with 1.53, azithromycin and norfloxacin with 1.3 each, nitrofurantoin with 0.56, and clarithromycin with 0.53 DDD/TID. Hospital utilization accounted for 7.1% of overall antibiotic utilization expressed in DDD/TID and 22.7% of the respective financial cost, predominated by aminoglycosides (J01G) with 72% and 94.2%, and lowest proportion of tetracyclines (J01A) with 4.3% and 2.4%, respectively. Conclusion: The utilization of antibiotics in Croatia is among the highest in Europe, mostly due to overuse of amoxicillin + clavulanic acid, which has no rational ground in professional guidelines. The analysis revealed the utilization to be predominated by expensive antibiotics, calling for due measures for rationalization of antibiotic utilization in Croatia.

utilization; antibiotic; Zagreb

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