Abstract
Purpose
The abundant use of antibiotics (Abs) in the community plays a major role in inducing Ab resistance, but the literature concerning patterns in outpatient Ab use is limited. This study aims to lay the foundations for future policy and interventional programs to address the rise in Ab resistance by looking at long-term trends in Ab usage in Israel.
Methods
Defined daily doses per 1,000 inhabitants per day (DID) of total Ab use, consumption in different age groups, and of different Ab preparations were calculated for the years 2000, 2005, and 2010 in the eight districts of Israel. Data were collected from the pharmacy registries of “Clalit Health Services”, the largest Health Maintenance Organization (HMO) in Israel, covering 4 million patients, representing 53 % of the population. Trends in use over time were analyzed.
Results
The overall Ab usage in Israel has remained constant in the last decade. Three significant trends were identified in this study: an increase in the consumption of expensive, broad-spectrum Abs, paralleled by a reduction in narrow-spectrum Abs; an increase in Ab consumption among the elderly, counteracted by reduced usage among children; large regional variations in the overall and specific use of Ab agents.
Conclusions
Our main findings of increased broad-spectrum Ab consumption, primarily among the adult population in Israel, and a wide variability in Ab use between the regions in Israel, can focus our future studies on searching for the factors behind these trends to aid in constructing interventional methods for decreasing outpatient Ab overuse.
Similar content being viewed by others
References
Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). J Antimicrob Chemother. 2011;66:vi3–12.
van de Sande-Bruinsma N, Grundmann H, Verloo D, Tiemersma 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;14:1722–30.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2012. Oslo. 2011.
Goossens 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;44:1091–5.
Low DE. Antimicrobial drug use and resistance among respiratory pathogens in the community. Clin Infect Dis. 2001;33:S206–13.
Kiffer CR, Camargo EC, Shimakura SE, Ribeiro PJ Jr, Bailey TC, Pignatari AC, Monteiro AM. A spatial approach for the epidemiology of antibiotic use and resistance in community-based studies: the emergence of urban clusters of Escherichia coli quinolone resistance in Sao Paulo, Brasil. Int J Health Geogr. 2011;10:17.
Versporten A, Coenen S, Adriaenssens N, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): outpatient penicillin use in Europe (1997–2009). J Antimicrob Chemother. 2011;66:vi13–23.
Versporten A, Coenen S, Adriaenssens N, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): outpatient cephalosporin use in Europe (1997–2009). J Antimicrob Chemother. 2011;66:vi25–35.
Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H; ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): outpatient quinolone use in Europe (1997–2009). J Antimicrob Chemother. 2011;66:vi47–56.
Kotwani A, Holloway K. Trends in antibiotic use among outpatients in New Delhi, India. BMC Infect Dis. 2011;11:99.
Hicks LA, Chien YW, Taylor TH Jr, Haber M, Klugman KP; Active Bacterial Core Surveillance (ABCs) Team. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996–2003. Clin Infect Dis. 2011;53:631–9.
Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M, Hirschl AM, Andersen LP, Goossens H, Glupczynski Y; on behalf of the Study Group participants. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2012. (Epub ahead of print).
Barr DA, Semple L, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) in a teaching hospital-based practice: a retrospective cohort study describing experience and evolution over 10 years. Int J Antimicrob Agents. 2012;39:407–13.
Dommergues MA, Hentgen V. Decreased paediatric antibiotic consumption in France between 2000 and 2010. Scand J Infect Dis. 2012;44:495–501.
Schneider-Lindner V, Quach C, Hanley JA, Suissa S. Secular trends of antibacterial prescribing in UK paediatric primary care. J Antimicrob Chemother. 2011;66:424–33.
Franchi C, Sequi M, Bonati M, Nobili A, Pasina L, Bortolotti A, Fortino I, Merlino L, Clavenna A. Differences in outpatient antibiotic prescription in Italy’s Lombardy region. Infection. 2011;39:299–308.
Pan A, Buttazzi R, Marchi M, Gagliotti C, Resi D, Moro ML; Antibiotic Use and Resistance Surveillance Study Group of Regione Emilia-Romagna. Secular trends in antibiotic consumption in the adult population in Emilia-Romagna, Italy, 2003–2009. Clin Microbiol Infect. 2011;17:1698–703.
Filippini M, Masiero G, Moschetti K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy. 2006;78:77–92.
Koller D, Hoffmann F, Maier W, Tholen K, Windt R, Glaeske G. Variation in antibiotic prescriptions: is area deprivation an explanation? Analysis of 1.2 million children in Germany. Infection. 2012. (Epub ahead of print).
Nitzan O, Low M, Lavi I, Hammerman A, Klang S, Raz R. Variability in outpatient antimicrobial consumption in Israel. Infection. 2010;38:12–8.
Conflict of interest
All authors have nothing to declare.
Author information
Authors and Affiliations
Corresponding author
Additional information
M. Low and O. Nitzan contributed equally to this work.
Rights and permissions
About this article
Cite this article
Low, M., Nitzan, O., Bitterman, H. et al. Trends in outpatient antibiotic use in Israel during the years 2000–2010: setting targets for an intervention. Infection 41, 401–407 (2013). https://doi.org/10.1007/s15010-012-0332-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-012-0332-8