Differences in outpatient antibiotic prescription in Italy’s Lombardy region

Franchi, Carlotta; Sequi, Marco; Bonati, Maurizio; Nobili, Alessandro; Pasina, Luca; Bortolotti, Angela; Fortino, Ida; Merlino, Luca; Clavenna, Antonio

doi:10.1007/s15010-011-0129-1

Cited by 31 publications

(41 citation statements)

References 35 publications

(37 reference statements)

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“…Although some conditions do not typically benefit from antibiotic therapy, these drugs are frequently used to treat colds and bronchitis (which are the most common conditions in children); and bacterial infections such as urinary tract infections (UTIs), pneumonia, and skin/soft tissue infections (common in the older adults). 5 It has been estimated that nearly 50% of children's antibiotic prescriptions are unnecessary 6 and do not comply with national guidelines. 7 Antibiotic misuse causes unnecessary expenditure, overuse of health services (as patients keep consulting their general practitioners [GPs] for subsequent similar problems), unnecessary side effects, and the possible development of antibiotic resistance.…”

Section: Introductionmentioning

confidence: 99%

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

Orlando

Monetti

Juste

et al. 2020

RMHP

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Purpose: The purpose was to analyze drug prescription and antibiotic use by age and sex in Italy's Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level. Methods: This was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient's municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test. Results: There were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults. Conclusion: A considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.

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Section: Introductionmentioning

confidence: 99%

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

Orlando

Monetti

Juste

et al. 2020

RMHP

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“…The observed differences confirm the need for a careful monitoring with the aim to reduce antibiotic resistance and improve the rational use of drugs [5]. Clinical evaluation should also include comorbilities as valvulopathy or immunosuppression.…”

Section: Discussionmentioning

confidence: 85%

“…On the other hand, emergency departments are at more risk of malpractice claims due to their quick pace, lack of patient-physician relationships, and patient expectations and demands; it can be assumed that this results in unnecessary, expansive care [4]. Furthermore, resistance to many antibiotics is a constantly *Address correspondence to these authors at the Dipartimento di Medicina Interna e Terapia Medica Sezione di Gerontologia e Geriatria, Università degli Studi di Pavia, Italy; Tel: 338/7699872; Fax: 338/3197191; E-mail: perfie@yahoo.com growing problem, especially in Lombardy, Italy; among the population of Lombardy, those who live in our city, Brescia statistically have a significantly higher risk of antibiotic drug exposure [5].…”

Section: Introductionmentioning

confidence: 99%

Use of Antibiotics for Epidermal Wounds in Emergency Room: Correct Prophylaxis and Right Choice of the Treatment

Pacioni¹,

Amadori²,

Raed³

et al. 2013

TOEMJ

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Abstract:Background: antibiotic therapy and prophylaxis of epidermal wounds in emergency room are often made empirically in case of clinics due to infective complications, although there are no scientific evidences supporting their validity yet. Furthermore, resistance to many antibiotics is a constantly growing problem, especially in Lombardy, Italy. When needed, better prefer beta-lactams or macrolides for their large-spectrum activity. Methods:We identified all patients (pts) treated to our emergency room for epidermal wounds in a period between 1st and 31st july 2012. Then, we performed a retrospective, observational analysis of epidemiological, clinical and therapeutic features of those pts. <12 years old individuals were exluded. We considered at high risk of infections pts with at least one of the following comorbidities: diabetes, neoplastic disease, therapy with corticosteroids, immunodepression.Results: A total of 201 pts were evaluated, 143 males (71.1%) and 58 females (28.9%). The median age was 46,3 yrs. Among the pts 101 (50.2%) needed treatment with suture. 13 (6.5%) pts came after at least 12 hrs after the accident. 107 (53,2%) pts did not need therapy, while in 82 (40.8%) cases antibiotic prophylaxis (89% beta-lactams, 9.8% macrolides, 1.2% others) has been prescribed; 4 (2%) were adviced to start antibiotic therapy only in case of acute epidermal infection development at home; we don't have this information about 8 pts (4%). In 185 (93.5%) pts clinical signs of acute epidermal infection were missing. 15 (7.5%) pts had an high risk of developing infections in history taking; 3 of them received antibiotic prophylaxis, 8 didn't, 4 not known. In 143 individuals (71,1%) the history taking has been insufficient. Conclusions:Even if acute local infection is possible in wounded pts, only subjects at high risk should be closely screened and monitored to detect early infection, in order to evaluate the necessity of specific antibiotic therapy. Clinical evaluation should also include comorbilities as valvulopathy or immunosuppression.

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“…Typically, geographic differences are assessed using analytical methods addressing the central tendency of the dispensing rates. [1][2][3][4][5][6][7][8][9] Considering the public health implications of high vs. low antibiotic use, examining the characteristics of the extreme quantiles may be of greater interest. Identifying predictors for high consumption may pinpoint areas for interventions and may contribute to optimize the effect of interventions to reduce antibiotic consumption.…”

Section: Abstract Antibiotic Consumption Latitude Municipality Sizementioning

confidence: 99%

Antibiotics to outpatients in Norway—Assessing effect of latitude and municipality population size using quantile regression in a cross‐sectional study

Haugen

Simonsen

Primicerio

et al. 2017

Pharmaceutical Statistics

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High antibiotic consumption rates are associated to high prevalence of antimicrobial resistance. Geographical differences in dispensing rates of antibiotics are frequently analysed using statistical methods addressing the central tendency of the data. Yet, examining extreme quantiles may be of equal or greater interest if the problem relates to the extremes of consumption rates, as is the case for antimicrobial resistance. The objective of this study was to investigate how geographic location (latitude) and municipality population size affect antibiotic consumption in Norway. We analysed all outpatient antibiotic prescriptions (n > 14 000 000) in Norway between 2004 and 2010 using quantile regression. Data were stratified by year, and we aggregated individual data to municipality, county, or latitudinal range. We specified the quantile regression models using directed acyclic graphs and selected the model based on Akaike information criteria. Yearly outpatient antibiotic consumption in Norway varied up to 10-fold at municipality level. We found geographical variation to depend on the number of inhabitants in a municipality and on latitude. These variables interacted, so that consumption declined with increasing latitude when municipality population sizes were small, but the effect of latitude diminished as the number of inhabitants increased. Aggregation to different levels of spatial resolution did not significantly affect our results. In Norway, outpatient antibiotic dispensing rates decreases with latitude at a rate contingent on municipality population size. Quantile regression analysis provides a flexible and powerful tool to address problems related to high, or low, dispensing rates.

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Differences in outpatient antibiotic prescription in Italy’s Lombardy region

Abstract: The observed intra-regional differences underline the need for a careful monitoring with the aim to reduce antibiotic resistance and improve the rational use of drugs.

Cited by 31 publications

References 35 publications

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

<p>Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation</p>

Use of Antibiotics for Epidermal Wounds in Emergency Room: Correct Prophylaxis and Right Choice of the Treatment

Antibiotics to outpatients in Norway—Assessing effect of latitude and municipality population size using quantile regression in a cross‐sectional study

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