Analysis of the causes and consequences of decreased antibiotic consumption over the last 5 years in Slovenia.
OBJECTIVE
Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.


METHODS
The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on 'antibiotic drugs' and 'bacterial resistance' during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained.


RESULTS
The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=-0.73 for the C-reactive protein test and -0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption.


CONCLUSIONS
Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.
Cizman
M
M
University Medical Centre, Department of Infectious Diseases, Japljeva 2, 1525 Ljubljana, Slovenia. milan.cizman@mf.uni-lj.si
Srovin
T
T
Pokorn
M
M
Cad Pecar
S
S
Battelino
S
S
D000553:Ambulatory Care; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D008417:Mastoiditis / Q000453:epidemiology; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D017524:Slovenia / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D019980:Amoxicillin-Potassium Clavulanate Combination