Outpatient Antibiotic Dispensing for the Population with Government Health Insurance in Syria in 2018–2019

Aljadeeah, Saleh; Wirtz, Veronika J.; Nagel, Eckhard

doi:10.3390/antibiotics9090570

Cited by 10 publications

(16 citation statements)

References 36 publications

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“…In terms of consumption volume, "Access" group relatively showed higher outpatient antibiotic dispensing patterns (3.21 DDD/100 outpatients per day). This is in contrast to study from Syria, 40 where higher percentage accounted for "Watch" group (13.26 DDD/1000 inhabitants per day).…”

Section: Discussioncontrasting

confidence: 98%

“…This was lower than reports from other countries, such as Tanzania (4.99 DDD/1000 inhabitants per day), 37 Montenegro (39.05 DDD/1000 inhabitants/day), 38 Slovenia (59.8 DDD/1000 inhabitants per day), 39 and Syria (20.13 DDD/1000 inhabitants per day). 40 However, nearly approachable result with study from Croatia (3.29 DDD/1000 inhabitants per day). 41 Unlike the study from Tanzania, 37 and Montenegro 38 where the penicillins, quinolones and tetracycline were consumed most frequently, in the current study tetracycline (doxycycline) was consumed most frequently (1.59 DDD/100 outpatients per day) followed by fluoroquinolones (1.48 DDD/100 outpatients per day) and penicillins (1.13 DDD/100 outpatients per day).…”

Section: Discussionmentioning

confidence: 93%

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Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Melaku¹,

Gashaw²,

Chelkeba³

et al. 2021

IDR

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Introduction Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia. Methods A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization “AWaRe” classification scheme as “Access”, “Watch” and “Reserve” group antibiotics and measured their consumption intensity. Results A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the “Watch” group had 2.10 DDD/100 outpatients per day. Conclusion There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the “Watch” group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 93%

Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Melaku¹,

Gashaw²,

Chelkeba³

et al. 2021

IDR

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show abstract

“…In Colombia, the share of Watch-group antibiotics was only 17% of all prescribed antibiotics in 2020, and living in a municipality increased the probability of receiving Watch- or Reserve-group antibiotics in comparison to living in capital cities [ 24 ]. On the other hand, very high proportions of Watch-group antibiotics were identified in Syria (66% in 2018–2019) [ 25 ] and Kazakhstan (61–68% in 2017–2019 period) [ 26 ], indicating the irrational use of antibiotics and the need for the improvement of current national policies in order to prevent the spread of AMR.…”

Section: Discussionmentioning

confidence: 99%

Increase and Change in the Pattern of Antibiotic Use in Serbia (2010–2019)

et al. 2021

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The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010–2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.

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“…Therefore, adjusting CVDs and diabetes medicines dispensing rates according to governorates by calculating the number of DDDs per 1000 beneficiaries (of each governorate) per day can be misleading. The CVDs and diabetes medicines dispensing rates were adjusted according to governorates by calculating the number of DDDs per 1000 medicine dispensing events per day (DDED) [36]. The medicine dispensing events here refers to the dispensing of CVDs or diabetes medicines.…”

Section: Discussionmentioning

confidence: 99%

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

Aljadeeah

Nagel

Wirtz

2021

BMC Health Serv Res

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Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.

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Outpatient Antibiotic Dispensing for the Population with Government Health Insurance in Syria in 2018–2019

Cited by 10 publications

References 36 publications

Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Increase and Change in the Pattern of Antibiotic Use in Serbia (2010–2019)

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019: a retrospective analysis

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