title: Trends in outpatient antibiotic use in Israel during the years 2000-2010: setting targets for an intervention.
abstract: OBJECTIVE
  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.
authors.affiliation: Clalit Research Institute and Chief Physician's Office, Clalit Health Services, 101 Arlozorov St., 62098, Tel Aviv, Israel. marcelolo@clalit.org.il
authors.forename: M
authors.initials: M
authors.lastname: Low
authors.forename: O
authors.initials: O
authors.lastname: Nitzan
authors.forename: H
authors.initials: H
authors.lastname: Bitterman
authors.forename: C
authors.initials: C
authors.lastname: Cohen
authors.forename: A
authors.initials: A
authors.lastname: Hammerman
authors.forename: N
authors.initials: N
authors.lastname: Lieberman
authors.forename: R
authors.initials: R
authors.lastname: Raz
authors.forename: R D
authors.initials: RD
authors.lastname: Balicer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends*; D024841:Fluoroquinolones / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007557:Israel; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000188:drug therapy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D019980:Amoxicillin-Potassium Clavulanate Combination