Skip to main content

Advertisement

Log in

Variability in Outpatient Antimicrobial Consumption in Israel

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Background:

Antibiotic consumption has an important effecton microbial resistance. Nationwide data on the comparativeuse of antibiotics in outpatient settings in Israel have onlybeen partially collected and published. The aim of our studywas to analyze the use of antibiotics in the outpatient settingin Israel and assess a number of influencing factors.

Materials and Methods:

Defined daily doses per 1,000inhabitants per day (DID) of total antibiotic use, consumptionin different age groups, and consumption of differentantibiotic groups were calculated for the years 2003–2005 inthe districts of Israel. The data was collected from prescriptiondata compiled by the pharmaceutical services of"Clalit Health Services", the largest health maintenanceorganization (HMO) in Israel, covering 55% of the population.Trends in use and variables associated with antibioticconsumption were analyzed.

Results:

There was a significant decrease in antibiotic usefrom 2003 to 2005, ranging from 1.8 to 8.2% in the differentdistricts. The highest consumption was noted in the youngestage groups, with more than half of all antibiotics prescribed tochildren ≤ 18 years of age. Antibiotic consumption was significantlydifferent between the different regions in Israel. Amultivariate analysis revealed that a higher prevalence of diabetesmellitus was the only significant variable associated withantibiotic use. Variability in the use of different antibiotics wasalso found; for example, amoxicillin comprised 19.5–33.4% oftotal antibiotic consumption in the different districts, whilefluoroquinolone consumption ranged from 3.2 to 7.3%.

Conclusions:

Outpatient antibiotic use in the populationinsured by "Clalit Health Services" declined between 2003and 2005. Children had the highest consumption rates. Therewere large differences in antibiotic use between geographicregions, and diabetes mellitus was the only variable significantly associated with antibiotic use. We therefore concludethat most of the differences in antibiotic use are likely due todoctor preferences, local routines, and patients’ attitudesand expectations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ferech M, Coenen S, Malhotra-Kumar S, Dvorakova K, Hendrickx E, Suetens C, Goossens H, ESAC Project Group: European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe. J Antimicrob Chemother 2006; 58: 401–407.

    Article  CAS  PubMed  Google Scholar 

  2. Goosens H, Ferech M, Coenen S, Stephens P, European Surveillance of Antimicrobial Consumption Project Group: Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries. Clin Infect Dis 2007; 44: 1091–1095.

    Article  Google Scholar 

  3. Van de Sande-Bruinsma N, Grundmann H, Verloo D, Toemersma E, Monen J, Goossens H, Ferech M, European Antimicrobial Resistance Surveillance System Group; European Surveillance of Antimicrobial Consumption Project Group: Antimicrobial drug use and resistance in Europe. Emerg Infect Dis 2008; 14: 1722–1730.

    Article  PubMed  Google Scholar 

  4. World Health Organization Collaborating Center for Drug Statistics Methodology. ATC/DDD Index. 2005. Available at: http://www.whoc.no/atcddd/

  5. Johnson A: Outpatient consumption of antibiotics is linked to antibiotic resistance in Europe: results from the European Surveillance of Antimicrobial Consumption. Euro Surveill 2005; 10: E050224.5.

    PubMed  Google Scholar 

  6. Kahan NR, Chinitz DP, Waitman DA, Kahan E: When gatekeepers meet the sentinel: the impact of a prior authorization requirement for cefuroxime on the prescribing behaviour of community-based physicians. Br J Clin Pharmacol 2006; 61: 341–344.

    Article  PubMed  Google Scholar 

  7. Kopylov U, Admon G, Borer A, Schlaeffer F, Aviram EE, Gilad J: Auditing and benchmarking of azithromycin utilization in primary care military clinics. Mil Med 2007; 172: 1065–1070.

    PubMed  Google Scholar 

  8. Nitzan O, Sophonitsky U, Colodner R, Kennes Y, Chazan B, Raz R: The return of chloramphenicol (submitted).

  9. Akici A, Kalaça S, Uĝurlu MU, Oktay S: Prescribing habits of general practitioners in the treatment of childhood respiratory-tract infections. Eur J Clin Pharmacol 2004; 60: 211–216.

    Article  PubMed  Google Scholar 

  10. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle P-Y, Watier L, Guillemot D: Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002–2007. PLoS Med 2009; 6: e1000084.

    Article  PubMed  Google Scholar 

  11. Dagan R, Barkai G, Givon-Lavi N, Sharf AZ, Vardy D, Cohen T, Lipsitch M, Greenberg D: Seasonality of antibiotic-resistant Streptococcus pneumoniae that causes acute otitis media: a clue for an antibiotic-restriction policy? J Infect Dis 2008; 197: 1094–1102.

    Article  PubMed  Google Scholar 

  12. Kern WV, de With K, Nink K, Steib-Bauert M, Schroder H: Regional variation in outpatient antibiotic prescribing in Germany. Infection 2006; 34: 269–273.

    Article  CAS  PubMed  Google Scholar 

  13. Filippini M, Masiero G, Moschetti K: Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Polity 2006; 78: 77–92.

    Article  Google Scholar 

  14. Davey P, Ferech M, Ansari F, Muller A, Goossens H, ESAC Project Group: Outpatient antibiotic use in the four administrations of the UK: cross-sectional and longitudinal analysis. J Antimicrob Chemother 2008; 62: 1441–1447.

    Article  CAS  PubMed  Google Scholar 

  15. Shalit I, Low M, Levy E, Chowers M, Zimhony O, Riesenberg K, Bishara J, Raz R: Antibiotic use in 26 departments of internal medicine in 6 general hospitals in Israel: variability and contributing factors. J Antimicrob Chemother 2008; 62: 196–204.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Raz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nitzan, O., Low, M., Lavi, I. et al. Variability in Outpatient Antimicrobial Consumption in Israel. Infection 38, 12–18 (2010). https://doi.org/10.1007/s15010-009-9065-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-009-9065-8

Keywords

Navigation