Outpatient use of systemic antibiotics in croatia

The aim was to estimate the outpatient utilization of antibacterials for systemic use in Zagreb, Croatia, and to define the antibiotic utilization characteristics and consequences.

Using the WHO ATC/DDD methodology, the number of defined daily doses per 1000 inhabitants per day (DDDs/TID) was calculated for each individual antibiotic and ATC system levels were calculated from data collected on the number and size of packages prescribed and dispensed from pharmacies. The Drug Utilization 90% (DU90%) method was used to evaluate the quality of drug prescribing.

The total utilization of antibiotics was found to be extremely high, 55.0 DDDs/TID. The leading antibiotic was amoxicillin + clavulanic acid with 14.7 DDDs/TID. Penicillins accounted for the highest utilization (46.3%) expressed in DDDs/TID (25.4), followed by cephalosporins and macrolides 25 and 12.5% of utilization, respectively expressed in DDDs/TID), tetracyclines, quinolones, aminoglycosides and other agents. Nine of 27 antibiotics fell within the DU90% segment. The cost/DDD foldrugs within DU90% segment was 1.2 EUR, for drugs beyond DU90% segment was 1.4 EUR, and the average was 1.2 EUR.

Irrational prescribing and preference to more expensive drugs have been reported in Zagreb. Therefore, the risk of resistance of microorganisms to beta-lactamase antibiotics, macrolides and quinolones could be expected. Prescribing patterns should be changed by introducing national guidelines on rational antibiotic prescribing, monitoring and evaluation of their implementation. Additional continuing education of physicians and pharmacists from independent sources should be organized and proper education should be provided to patients.