Title of the publicationThe influence of a sustained multifaceted approach to improve antibiotic prescribing in Slovenia during the past decade: findings and implications
Abstract

Introduction: Rising antibiotic resistance has become an increasing public health problem.
There is a well-established correlation between antibiotic consumption and antimicrobial resistance. Consequently, measures to rationalize the prescribing of antibiotics should reduce the resistant strains. Following a 24% increase in antibiotic consumption at the end of the 1990s, multiple activities were designed and introduced by the Health Insurance Institute of Slovenia (ZZZS) and other organizations in Slovenia at the end of 1999. These activities reduced the antibiotic consumption by 18.7% by 2002. These measures have continued.
Objective: To study changes in antibiotic utilization from 1995 to 2012 alongside the multiple interventions and their consequences, including changes in resistance patterns. Methods: This was a retrospective observational study involving all patients dispensed at least one ZZZS prescription for an antibiotic in Slovenia. Utilization was expressed in defined daily doses per thousand inhabitants per day. Multifaceted interventions were conducted over time involving all key stakeholder groups, that is, the Ministry of Health, ZZZS, physician groups and patients. These included comprehensive communication programs as well as prescribing restrictions for a number of antibiotics and classes. Results: From 1999 to 2012, antibiotic consumption decreased by 2–9% per year, with an overall decrease of 31%. There were also appreciable structural changes. Overall antibiotic utilization and the utilization of 7 out of 10 antibiotics significantly decreased after multiple interventions. The resistance of Streptococcus pneumoniae to penicillin decreased in line with decreased utilization. However, its resistance to macrolides increased from 5.4 to 21% despite halving of its utilization. The resistance of Escherichia coli to fluoroquinolones doubled from 10 to 21% despite utilization decreasing by a third. Expenditures on antibiotics decreased by 53%. Conclusion: Multiple demand-side measures introduced following increased utilization significantly decreased subsequent antibiotic utilization and associated costs. However, there was variable impact on antibiotic resistance. Additional targeted activities are planned to further reduce antibiotic prescribing and resistance.

DOIhttps://doi.org/10.1586/14787210.2015.990381
Name of the first authorFürst, Jurij
Year of publication2015
Study design of the publicationCross sectional study
Method for data collection and analysis
  • Quantitative data - Quantitative data were used during the intervention
Quantitative data - Quantitative data were used during the intervention
Scientific references about the intervention or other assessment of the intervention

Cizman M, Srovin T, Pokorn M, et al. Analysis of the causes and consequences of decreased antibiotic consumption over the last 5 years in Slovenia. J Antimicrob Chemother 2005;55(5):758-63
Godman B, Shrank W, Andersen M, et al. Comparing policies to enhance prescribing efficiency in Europe through increasing generic utilization: changes seen and global implications. Expert Rev Pharmacoecon Outcomes Res 2010;10(6):707-22
Earnshaw S, Monnet DL, Duncan B, et al. European Antibiotic Awareness Day, 2008 - the first Europe-wide public information campaign on prudent antibiotic use: methods and survey of activities in participating countries. Euro Surveill 2009;14(30):19280
Adriaenssens N, Coenen S, Versporten A, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient quinolone use in Europe (1997-2009). J Antimicrob Chemother 2011;66(Suppl 6):vi47-56

Other references about the intervention or other assessment of the intervention

WHO Collaborating Centre for Drug Statistics Methodology. ATC/ DDD index 2011. WHO, Oslo. 2013. Available from: www.whocc.no/atc_ddd_index/
Čižman M, Beović B. Priročnik za ambulantno predpisovanje protimikrobnih zdravil. Ljubljana: Arkadija 2002
ZZZS. Recept – The bulletin on drugs covered by Compulsory Health Insurance. 2013. Available from: www.zzzs.si/zzzs/info/egradiva.nsf/o/FEAF7D3377DA0E13C1257A2C003406A3?
ZZZS. Varna raba zdravil. Available from: https://zavarovanec.zzzs.si/wps/portal/portali/azos/domov2013
Bagari Bizjak N, Fürst J, Kramberger B, et al. Kakovost predpisovanja v družinski medicini. Recept 2011;9(1):93-5

Sector
  • Human - All activities regarding organisations and individuals involved in health products and services
Sub-sectorSub-sectors are further units of demarcation within a sector E.g. awareness campaign from veterinarians to cat owners about toxoplasmosis drug resistance and transmission of resistant bacteria: ANIMAL, PETS
Subsector (human)
  • Healthcare delivery
Healthcare delivery