Variabilidad de la prescripción antibiótica en las infecciones respiratorias en dos países de Europa

Differences in outpatient antibiotic use between a Spanish region and a Nordic country

INTRODUCTION

Antibiotic use and misuse are linked to pathogen resistance and, as such, both constitute a public health issue with local, national, and global dimensions. Early studies have shown striking variations in the use of these drugs between Nordic and Mediterranean countries. The aim of the present study was to describe and compare antibiotic prescribing in Primary Care in Denmark and Aragón (a North-eastern Spanish region).

METHODS

Outpatient antibiotic prescription data (2010) were obtained from the National Institute for Health Data and Disease Control (Denmark), and the Information System on Medication Consumption in Aragón. The consumption of antibiotics (ATC J01) was analyzed from the prescription rates and the number of defined daily dose (DDD) per 1000 inhabitants/day (DID).

RESULTS

The rate of antibiotic prescription in 2010 in Aragón was greater than in Denmark (407 compared to 315 exposed individuals/1000 inhabitants). There were significant differences as regards overall consumption of antibiotics (23.2 DID in Aragón and 17.0 DID in Denmark), as well as the therapeutic group selection. There was an elevated use of broad spectrum penicillins, quinolones and cephalosporins in the Spanish region while, in Denmark, the most-consumed antibiotic was narrow spectrum penicillin.

CONCLUSION

The use of antibiotics in the Spanish region is very high, and there are marked differences in the choice of drug between this region and Denmark. Interventions are needed that promote the rational use of these drugs to reduce potential bacterial resistance, and to avoid unnecessary risks to patients.

[Infectious disease in primary care: 1-year prospective study]

INTRODUCTION

The frequency and seasonal variability of infectious diseases was determined in patients consulting in the primary care setting.

METHODS

In 2007, an observational, prospective study was conducted, including all persons older than 14 with infectious diseases consulting at 2 primary care practices. All infectious diseases identified over the 1-year period were recorded using a template with the following variables: age and sex, present diagnosis, prescription of an antibiotic or not, diagnostic tests used, and referral to a specialist or not.

RESULTS

Out of 12,676 patients attended over the year, 4214 presented at least one infectious disease (33.2%). A total of 4353 infections were observed, in patients with a mean age of 44.1 years (SD: 12.1). The most common infectious diseases were respiratory infections (2196, 50.4%), followed by skin infections (586, 13.5%) and urinary tract infections (452, 10.4%). The incidence of infections ranged from 39.8% in January to 30.7% in August. The greatest seasonal variation was related to respiratory tract infections, which were more frequent in winter (69.2%) and less common in summer (25.1%), whereas skin infections accounted for 22.6% of all infectious diseases in summer. A total of 962 patients had self-administered antimicrobial agents (22.8%). In respiratory tract infections, the percentage of antimicrobials self-administered by patients was greater than the percentage of prescriptions by physicians (22.2% vs. 14.7%, respectively).

CONCLUSION

Infectious diseases account for one third of the visits to a general practitioner and half of these cases correspond to respiratory tract infections. There is a seasonal variation in infections, mainly for respiratory infections.

Moxifloxacin: a respiratory fluoroquinolone

BACKGROUND

Respiratory quinolones are a class of antimicrobials with a high activity against most respiratory pathogens. Moxifloxacin is a fourth-generation fluoroquinolone that has been shown to be effective against Gram-positive, Gram-negative, and atypical strains, as well as multi-drug resistant Streptococcus pneumoniae.

OBJECTIVE

To review and update the clinical efficacy of moxifloxacin in the treatment of respiratory infections.

METHOD

To perform a systematic review of publications on the clinical efficacy of moxifloxacin in respiratory infections.

RESULTS

The clinical efficacy of moxifloxacin has been shown in controlled studies of community-acquired pneumonia, exacerbations of chronic bronchitis and acute bacterial rhinosinusitis. Moxifloxacin has demonstrated a faster resolution of symptoms in community-acquired pneumonia and exacerbations of chronic bronchitis patients compared with first-line therapy together with excellent eradication rates.

CONCLUSIONS

The use of moxifloxacin as first-line therapy for moderate to severe respiratory infections in the community and the hospital has been recognized in international guidelines.

Variabilidad de la prescripción de antibióticos en la población pediátrica de Castilla y León durante los años 2001 a 2005 en el medio urbano o rural

OBJECTIVES

To compare systemic antibiotic prescribing in the pediatric population of Castile and Leon in relation to urban or rural setting.

MATERIAL AND METHODS

Data on non-hospital antibiotic consumption in the pediatric population were gathered from the database that processes the antibiotics billed in the Health Service of Castile and Leon. These data were analyzed according to the Anatomical Therapeutic Chemical Classification System (ATC) and the results were expressed as defined daily doses per 1000 inhabitants per day (DID).

RESULTS

Overall antibiotic consumption in the pediatric population was markedly higher in the rural setting (24.37 DID in rural areas vs. 19.54 DID in urban areas). Interannual variability was similar in both settings, with prescriptions reaching a peak in 2003. In the qualitative analysis, prescription of amoxicillin and, to a lesser extent, of cefixime and azithromycin was higher in rural areas. Differences in prescription in the urban and rural areas of the distinct health areas varied, the greatest differences being found in Segovia.

CONCLUSIONS

Wide quantitative and qualitative variability in antibiotic use was found between the various urban and rural zones of basic health areas. Although we suspected that the results for the urban setting would be underestimated due to the excessive use of emergency services, more detailed studies are required to better understand the determinants of antibiotic use in children.

Determining Factors in the Prescription of Moxifloxacin in Exacerbations of Chronic Bronchitis in??the Primary-Care Setting

OBJECTIVE

To describe the characteristics of patients and exacerbations that may determine the choice of an antibacterial in exacerbations of chronic bronchitis (ECB).

METHODS

This was a multicentre, observational study in ECB. A group of 225 primary-care practitioners were randomly selected to include 1007 patients. A logistic regression model was used to identify the characteristics of the physicians, patients and exacerbations associated with the choice of an antibacterial.

RESULTS

The mean age of the patients was 67.6 years (+/- SD 11) and 72.1% were male. In 91.4% of patients, the exacerbation was type I or II according to Anthonisen's classification. Most exacerbations (68.2%) were treated with moxifloxacin while only 31.8% were treated with other antibacterials. The more experienced practitioners (those with the longest professional careers and those who had higher numbers of patient-visits for chronic bronchitis) prescribed moxifloxacin more frequently (per each year of experience: OR 1.05; 95% CI 1.02, 1.07; per each additional patient-visit per week: OR 1.02; 95% CI 1.003, 1.04). The probability of receiving moxifloxacin increased with the severity of baseline dyspnoea (OR 1.94; 95% CI 1.27, 2.96) and decreased in smokers (OR 0.54; 95% CI 0.36, 0.81) and in patients receiving oral corticosteroids (OR 0.61; 95% CI 0.41, 0.90).

CONCLUSIONS

Prescription of moxifloxacin in primary care is significantly associated with more years of physician practice and with a higher severity of disease. The use of oral corticosteroids in exacerbations is commonly associated with other antibacterials (non-quinolones), either to improve antibacterial efficacy or because of doubtful bacterial aetiology, thus the preference for a narrow-spectrum antibacterial combined with an anti-inflammatory drug.