The appropriateness of prescribing antibiotics in the community in Europe: study design

Abstract

BackgroundOver 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the appropriateness of antibiotic prescribing in primary care in Europe by collecting and combining patterns of antibiotic resistance patterns and antibiotic prescription patterns in primary care. We will also evaluate the appropriateness of national antibiotic prescription guidelines in relation to resistance patterns.Methods/DesignAntibiotic resistance will be studied in an opportunistic sample from the community in nine European countries. Resistance data will be collected by taking a nose swab of persons (N = 4,000 per country) visiting a primary care practice for a non-infectious disease. Staphylococcus aureus and Streptococcus pneumoniae will be isolated and tested for resistance to a range of antibiotics in one central laboratory. Data on antibiotic prescriptions over the past 5 years will be extracted from the electronic medical records of General Practitioners (GPs). The results of the study will include the prevalence and resistance data of the two species and 5 years of antibiotic prescription data in nine European countries.The odds of receiving an effective antibiotic in each country will be calculated as a measure for the appropriateness of prescribing. Multilevel analysis will be used to assess the appropriateness of prescribing. Relevant treatment guidelines of the nine participating countries will be evaluated using a standardized instrument and related to the resistance patterns in that country.DiscussionThis study will provide valuable and unique data concerning resistance patterns and prescription behaviour in primary care in nine European countries. It will provide evidence-based recommendations for antibiotic treatment guidelines that take resistance patterns into account which will be useful for both clinicians and policy makers. By improving antibiotic use we can move towards controlling the resistance problem globally.

Prevalence and Antibiotic Resistance of Commensal Streptococcus Pneumoniae in Nine European Countries

“…The study design was described previously by van Bijnen et al [20]. In short, 20 general practitioners (GP) were recruited per country, by national GP networks in nine European countries (Austria, Belgium, Croatia, France Hungary, Spain, Sweden, The Netherlands and the UK), and aimed to each provide 200 nasal swabs, from patients older than 4 years, with the exception of the UK where patients were 18 years or older (due to ethical committee constraints).…”

“…The acquisition of antibiotic resistance in this environment is enhanced by the enormous potential of genomic exchange and mutations [19]. One of the aims of the APRES study, was to assess the prevalence and antibiotic resistance of nasal carriage of S. aureus and S. pneumoniae in general practice patients and to compare antibiotic resistance patterns of these isolates [20] with different antibiotic prescription policies. The results ofS.…”

Antimicrobial stewardship programmes: the need for wider engagement

“…Despite the majority of antimicrobial prescribing and consumption occurring in primary care settings,3 hospitalised populations experience the full force of antimicrobial resistance and difficult-to-treat multidrug resistant organisms 4…”

Padrão de prescrição de antibióticos no Algarve: características do doente e dispersão da terapêutica

“…Considerando a metodologia da recolha de dados, em que cada médico deveria recolher informação de forma consecutiva até perfazer 20 doentes nas consultas em que havia prescrição de antibióticos, não foi possível obter uma amostra estratificada por idade e género, de acordo com a distribuição da população no Algarve. Por outro lado, essa não seria porventura a amostra ideal visto que, geralmente, mulheres, crianças e idosos têm uma maior taxa de utilização dos serviços de saúde do que outros grupos 19 . No entanto, garantimos a participação de médicos de todos os centros de saúde do Algarve e, assim, também se assegurou a inclusão de prescriç ões de doentes de todos os concelhos desta região.…”