title: Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost.
abstract: OBJECTIVE
  The aims were to calculate total systemic antibiotic consumption and cost in both public and private sectors in all care settings in Al-Najaf province, Iraq, during 2012, recognize the percentage of each pharmacological class for the dispensed antibiotics and identify oral and parenteral antibiotic percentages dispensed and the portions manufactured nationally and imported.
  
  
  METHODS
  Cross-sectional study was conducted in Al-Najaf to calculate the total cost and quantities of antibiotics consumed during 2012 using World Health Organization Guidelines for Defined Daily Dose (DDD).
  
  
  RESULTS
  The results showed more than 21 million DDDs were dispensed in Al-Najaf in one year, and more than half (54.2%) were dispensed by governmental healthcare institutions. A thousand inhabitants in the province consumed 45.26 DDDs per day. Extended-spectrum (34.49%) and combined penicillins (26.08%) were the most frequently consumed while meropenem was the least frequently consumed (0.02%). Ninety-five per cent of the consumed antibiotics were oral dosage forms, and five per cent were parenteral dosage forms. The total cost of antibiotic consumed was more than nine million U.S dollars.
  
  
  CONCLUSIONS
  The antibiotic consumption ratio in this province was comparable to neighbouring countries, but far higher compared to European countries. Penicillins, cephalosporins and quinolones were the most popular antibiotics. Around half of the antibiotics consumed were made by national pharmaceutical companies that mainly produce oral antibiotics. The public sector consumed a higher portion, but spent a lower amount compared to private sectors. This is the first time report of antibiotic consumption in Iraq. More studies evaluating antibiotic consumption can improve utilization.
authors.affiliation: Pharmacy Practice and Science Department, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Al-Jumaili
authors.affiliation: Faculty of Pharmacy, Humanity Studies University College, Al-Najaf, Iraq.
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Hussein
authors.affiliation: Faculty of Pharmacy, Humanity Studies University College, Al-Najaf, Iraq.
authors.forename: Mohammed D
authors.initials: MD
authors.lastname: Al-Rekabi
authors.affiliation: AL-Najaf Healthcare Directorate, Najaf, Iraq.
authors.forename: Saba A
authors.initials: SA
authors.lastname: Raheem
authors.affiliation: Pharmacy Practice and Science Department, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Ernst
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics*; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D004345:Drug Industry / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D007263:Infusions, Parenteral / Q000706:statistics & numerical data; D007493:Iraq
chemical_list: D000900:Anti-Bacterial Agents
keywords: Iraq; antibiotics; consumption; cost