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Modalità di prescrizione in Italia degli antibiotici iniettabili e orali nel trattamento delle infezioni delle vie aeree inferiori negli anni 1993–2002

Outpatient prescribing patterns of antibiotics in Italy: parenteral vs oral use (1993–2002)

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PharmacoEconomics Italian Research Articles

Summary

Background

The utilisation of antibiotics in Italy is above the European average. This represents a concern because of both the possibility of abusing such drugs, and the risk of developing resistance. Third generation parenteral cephalosporins are among the antibiotics at higher risk for improper use, also corresponding to an increase in healthcare costs. The Italian Commissione Unica del Farmaco (CUF) has introduced (1994) some guidelines to limit the prescription of parenteral antibiotics in the outpatient setting.

Objectives

To evaluate the trends in parenteral cephalosporins consumption and costs versus oral antibiotics (penicillins and fluoroquinolones), pointing out the effects of the CUF guidance.

Methods

We only considered the most commonly used cephalosporins, chosen on the basis of their relevance for healthcare costs. The same criterium was followed when selecting oral penicillins and fluoroquinolones. Data related to the overall outpatient consumption (number of packages) of such drugs were used when analysing the demand. The content of each package was converted in overall DDD and normalized to DDD/1000 people/die. We also evaluated the demand and costs in the field of the lower airways infections.

Results

The demand for antibiotics for the treatment of lower airways infections has increased sistematically in the decade 1993–2002 (5% yearly), but the share of parenteral cephalosporins is decreasing since 1996. Cephalosporins have a higher cost (€ 20,8 per DDD in 2002) compared to oral antibiotics (fluoroquinolones: € 3,7 per DDD; penicillins € 1,1 per DDD). Compared to 1993, such a cost per DDD has dropped for parenteral cephalosporins (−19,4%) and for fluoroquinolones (−19,6%), while it has increased for oral penicillins (+22%). Despite the increase in demand, the overall expenditure for treatment of lower airways infections, after reaching a peak in 1997 (€ 318 millions), remained roughly constant until year 2000 (€ 311 millions) and then decreased by about 18% from year 2000 to 2002.

Conclusions

CUF guidance was altogether beneficial, promoting appropriate patterns of drug consumption in the outpatients setting, with a positive trend towards reduced demand of parenteral cephalosporins and positive effects on the overall expenditure.

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Authors and Affiliations

  1. Wolters Kluwer Health, Adis International Ltd Italia, Via Lanino 5, 20144, Milano, Italia

    Carlo Lucioni

  2. ULSS9, Servizio Farmaceutico Territoriale, Treviso, Italia

    C. Saramin

  3. Area Antibatterici, Direzione Medica, GlaxoSmithKline S.p.A, Verona, Italia

    F. Marchetti

Authors
  1. Carlo Lucioni
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  2. C. Saramin
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  3. F. Marchetti
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Corresponding author

Correspondence to Carlo Lucioni.

Additional information

I peer reviewers, per questo articolo, sono stati coordinati da Albano Del Favero.

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Lucioni, C., Saramin, C. & Marchetti, F. Modalità di prescrizione in Italia degli antibiotici iniettabili e orali nel trattamento delle infezioni delle vie aeree inferiori negli anni 1993–2002. Pharmacoeconomics-Ital-Res-Articles 6, 59–67 (2004). https://doi.org/10.1007/BF03320624

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  • DOI: https://doi.org/10.1007/BF03320624

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