Prevalence of antibiotic prescription in southern Italian outpatients: real-world data analysis of socioeconomic and sociodemographic variables at a municipality level

Abstract

PurposeThe aim of this study was to analyze the geographic variation in systemic antibiotic prescription at a regional level and to explore the influence of socioeconomic and sociodemographic variables.MethodsThis study was a retrospective analysis of reimbursement pharmacy records in the outpatient settings of Italy’s Campania Region in 2016. Standardized antibiotic prescription rates were calculated at municipality and Local Health Unit (LHU) level. Antibiotic consumption was analyzed as defined daily doses (DDD)/1000 inhabitants per day (DID). Logistic regression was performed to evaluate the association between antibiotic prescription and sociodemographic and socioeconomic determinants at a municipality level.ResultsThe average antibiotic prevalence rate was 46.8%. At LHU level, the age-adjusted prevalence rates ranged from 41.1% in Benevento to 51.0% in Naples2. Significant differences were found among municipalities, from 15.2% in Omignano (Salerno LHU [Sa-LHU]) to 61.9% in Moschiano (Avellino [Av-LHU]). The geographic distribution also showed significant differences in terms of antibiotic consumption, from 6.7 DID in Omignano to 41.6 in San Marcelino (Caserta [Ce-LHU]). Logistic regression showed that both municipality type and average annual income level were the main determinants of antibiotic prescription. Urban municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to rural municipalities (adjusted odds ratio [OR]: 8.62; 95% confidence interval [CI]: 4.06–18.30, P<0.001). Low average annual income level municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to high average annual income level municipalities (adjusted OR: 8.48; 95% CI: 3.45–20.81, P<0.001).ConclusionWe provide a snapshot of Campania’s antibiotic consumption, evidencing the impact of both socioeconomic and sociodemographic factors on the prevalence of antibiotic prescription. The observed intraregional variability underlines the lack of shared therapeutic protocols and the need for careful monitoring. Our results can be useful for decision makers to plan educational interventions, thus optimizing health resources and improving rational drug use.

Knowledge and practices regarding antibiotics use

“…It is worthwhile to underline that the proportion of individuals who reported having taken at least one antibiotic for himself/herself (47.9%) or for their minor son/daughter (55.4%) in the previous 12 months is among the highest reported in European Member States, emphasizing that antibiotic consumption is considerable in the study area as well as in the country as a whole [ 29 ]. A similar antibiotic consumption prevalence (46.8%) was observed in a retrospective analysis of reimbursement pharmacy records in the outpatient setting of another Region of Southern Italy [ 28 ].…”

“…The results of multivariate analysis underlined the heterogeneity of public knowledge regarding antibiotics and AMR on the basis of sociodemographic factors. These figures could be helpful as a considerable inter- and intraregional variability in antibiotic consumption and prescribing pattern has been already described in Italy [ 27 ] as well as its relationship with sociodemographic factors [ 28 ]. Our findings indicated that males, foreign nationals and those with a lower level of education had poor knowledge of antibiotics and AMR and could be highly useful in planning tailored educational interventions.…”

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

“…Furthermore, the study concluded that higher prevalence rates were related to urban municipalities and low average annual income levels. 16 In our study, we observed a statistically significant correlation of rank distributions of prevalence rates at municipality level between children, adults, and the older adults. Different factors may explain these geographical differences observed in all three groups, such as socio-cultural, demographic, economic determinants, as well as different prescribing attitudes between physicians.…”

“…15 According to earlier estimates of a recent study, in this region, there is a strong relationship between antibiotic prevalence rates and sociodemographic and socioeconomic factors at a municipality level. 16 Nevertheless, this work did not analyze prescriptive patterns related to age, sex and type of class of antibiotic drugs. Reason why, the aims of the present study are to (a) analyze outpatient drug prescriptions records in Campania to describe patterns of antibiotic use by age and sex, and (b) estimate the distribution of prevalence prescription rates in children, adults, and the older adults ≥65 years at a municipality level.…”

Development and validation of a clinical risk score to predict the risk of SARS-CoV-2 infection from administrative data: a population-based cohort study from Italy

“…The Campania Region Database (CaReDB) includes information on patient demographics, the electronic records of outpatient pharmacy dispensing and hospital discharges for ~6 million residents of a well-defined population in Italy (~10% of the population of Italy). CaReDB is complete and includes validated data in previous drug utilization studies [9][10][11][12][13][14][15][16][17]. The characteristics of CaReDB are described in S1 Table. From the beginning of the Covid-19 epidemic, a surveillance system was implemented to collect all cases identified by reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2.…”