title: Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice.
abstract: We provide a representative analysis of antibiotic prescribing, identify factors associated with broad-spectrum antibiotic prescribing and assess the costs associated with antibiotic use in adult outpatients in Greece. Outpatient antibiotic prescriptions for patients older than 19 years between 2010 and 2013 in Greece were extracted from the IMS Health Xponent database. Prescribing rate and total cost for prescribed antibiotics were calculated. Multivariate logistic regression was used to identify factors related to broad-spectrum antibiotic prescribing. More than 20 million antibiotics were prescribed during the study period, an annual rate of 768 prescribed antibiotics per 1,000 adults. Overall, 33.5% of antibiotics were prescribed for acute respiratory tract infections (ARTIs) for which antibiotics are often not indicated. Macrolides (29.9%), cephalosporins (26.9%) and fluoroquinolones (21.0%) were the most commonly prescribed antibiotic classes. The majority (89.0%) of antibiotics were broad-spectrum. Antibiotic expenditures were approximately EUR 185 million during the study period. Factors associated with broad-spectrum prescribing included older patient age, specialty pulmonologists or otorhinolaryngologists, training in eastern Europe, diagnosis of ARTI, acute diagnosis, and first episode of disease. Broad-spectrum antibiotic prescribing for ARTIs is common in adult Greek outpatients and frequently inappropriate. These data indicate the need for initiatives aiming to control antibiotic prescribing.
authors.affiliation: Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kourlaba
authors.forename: Effrossyni
authors.initials: E
authors.lastname: Gkrania-Klotsas
authors.forename: Eleni
authors.initials: E
authors.lastname: Kourkouni
authors.forename: Georgios
authors.initials: G
authors.lastname: Mavrogeorgos
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D015995:Prevalence; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: ambulatory patients; antibiotic use; antimicrobial prescription; cost; respiratory infections