Antibiotic Utilization Among People With Multiple Sclerosis in the Netherlands, 2018-2020

Area of Science:

• Pharmacology and Pharmacoepidemiology
• Neurology and Infectious Diseases

Background:

• Multiple sclerosis (MS) is a chronic neurological condition that may increase susceptibility to infections.
• Understanding antibiotic usage patterns in people with multiple sclerosis (pwMS) is crucial for managing their health and preventing antimicrobial resistance.

Purpose of the Study:

• To quantify and describe the intensity and patterns of antibiotic drug use among pwMS in the Netherlands.
• To compare antibiotic consumption in pwMS with the general outpatient population.

Main Methods:

• Utilized ambulatory hospital records and outpatient pharmacy dispensing data from the PHARMO Database Network (2018-2020).
• Calculated antibiotic intensity using defined daily doses (DDD)/1000 patient-days (PD).
• Analyzed dispensing patterns, including prolongations and switches, stratified by demographics, polypharmacy, disease-modifying treatments, and COVID-19 lockdown periods.

Main Results:

• 1960 (37.8%) of 5179 pwMS received at least one antibiotic prescription.
• Antibiotic use in pwMS was 18.8 DDD/1000 PD, substantially higher than the general population (7.77-8.90 DDD/1000 PD).
• Higher antibiotic use was observed in women, older individuals, and those with polypharmacy; use decreased during lockdown. Nitrofurantoin was the most frequent antibiotic.

Conclusions:

• Antibiotic consumption intensity is considerably higher among pwMS than the general population.
• This elevated use highlights the significant burden of infections experienced by pwMS.
• Findings underscore the need for targeted strategies to optimize antibiotic use in this vulnerable population.