Antimicrobial Prescribing Patterns in Russian Outpatients in 2024: Results of the Global-PPS Project

Detailed surveillance of antimicrobials' use in the community is an essential strategy to control their overuse and misuse. This study aimed to evaluate prescribing patterns of antimicrobials in Russian outpatients in 2024 and quantify the prescribing in relation to quality indicators.

A point prevalence study was conducted during January-April 2024 in 14 healthcare facilities in 11 Russian cities (Chelyabinsk, Ekaterinburg, Krasnoyarsk, Moscow, Novokuznetsk, Saratov, Smolensk, Ulan-Ude, Vladivostok, Yakutsk, and Yaroslavl) in accordance with the outpatient protocol of Global-PPS project. Detailed data on antimicrobials, age, gender, and drug indications were collected for each outpatient receiving at least one agent for prophylaxis or treatment.

A total of 5,084 outpatients from 149 units were surveyed, of which 487 (9.6%) received at least one antimicrobial agent. The highest rates of antimicrobial prescribing were observed at upper respiratory tract (33.2%), gastroenterology (22.6%), hematology (13.6%), ear nose and throat (13.5%), and gynecology units (11.6%). Antibacterials accounted for 63.4% of antimicrobials on average, followed by antivirals (35.4%). Penicillins (41.4%), for the most part penicillin/beta-lactamase inhibitor combinations (30.1%), cephalosporins (18.3%), including third generation (17.7%), fluoroquinolones (16.1%), and macrolides (11.5%) were the top classes of antibiotics prescribed. Umifenovir (23.8%) and amoxicillin/clavulanic acid (19.0%) were the top antimicrobials prescribed. The administered antibacterials were almost equally distributed between "access" (46.5%) and "watch" (53.5%) AWaRe groups. On average, choice of antimicrobials followed the national guidelines issued by the Ministry of Health in 73.2% of cases.

The pooled rates of antimicrobial prescribing in outpatient settings was 9.6% with the substantial differences in patterns of consumption overall and among the units of different types. Broad-spectrum antibacterials such as penicillin/beta-lactamase inhibitor combinations, III-IV generation cephalosporins, fluoroquinolones, and macrolides together amounted to 48% of prescriptions. Common concerns in antimicrobial drug usage included low guidelines compliance and low rate of "access" group antibacterials.