Antimicrobial Medicines Consumption in Eastern Europe and Central Asia - An Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action

<p>Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network.</p><p>Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action.</p><p>Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes.</p><p>Findings: Total J01 consumption in 2015 ranged 8.0–41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4–42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2–56.6, 9.4–28.8, and 7.5–24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3–49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7–38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3–35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest.</p><p>Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.</p

Generic drug prescribing in primary care: A nationwide analysis

Introduction Dissemination of generic drug (GD) use could provide significant savings on drug expenditures and contribute to the long-term sustainability of healthcare. We aimed to exhibit the nationwide trend of GD use in primary care and investigate potentially relevant drug and patient factors

Comparison of drugs prescribed by psychiatrists and child/adolescent psychiatrists

Background: Drug utilization patterns may vary between children and adults even for similar indications. Psychiatry is one of the areas where differences of both diagnosis and drug utilization often vary between age groups, imposed by respective separate subspecialties and their prescribing patterns. The study aimed to compare utilization of drugs prescribed by psychiatrists and child/adolescent psychiatrists (CPs).Methods: This study evaluated all electronic prescriptions that were generated by psychiatrists and CPs and registered to the national Prescription Information System in 2016. The drugs in these prescriptions were examined and compared in terms of physician groups.Results: Among 1,150,621 prescriptions generated by psychiatrists and CPs during the study year, 94.2% (n=1,083,631) belonged to psychiatrists and the remaining 5.8% (n=66,990) to CPs. Psychiatrists were detected to prescribe significantly fewer nervous system drugs than CPs did (89.5% vs. 97.8%, p<0.001). Antidepressants constituted 57.4% of all nervous system drugs prescribed by psychiatrists, which was significantly lower in the prescriptions of CPs as 22.1% (p<0.001). Within antidepressants, SSRIs were significantly more preferred by CPs (91.4%) than that by psychiatrists (56.2%), (p<0.001). Centrally-acting sympathomimetics formed 46.6% of nervous system drugs prescribed by CPs compared to 2.4% of that by psychiatrists (p<0.001). Among these sympathomimetics, methylphenidate was the most commonly preferred drug by both CPs and psychiatrists (%84.6% vs. %68.6, respectively; p<0.001).Conclusions: It seems that centrally-acting sympathomimetics constitute near half of the drugs preferred by CPs who tend to prescribe a limited number of different drugs. Contrarily, psychiatrists tend to prescribe wide spectrum of drugs, half of these being antidepressants. The study highlights some discrepancies of psychotropic drug use regarding approved indication and clinical practice for different age groups

Knowledge, opinions and attitudes of primary care physicians about generic drugs: A cross-sectional study

Background: Generic drug (GD) use is affected by many factors, including physicians' approach.Objective: This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors.Methods: An adequately representative sample (n = 354) of PCPs was determined via stratified and simple random sample selection method in this descriptive, cross-sectional study. The research data were collected through a face-to-face 40-item survey, where the knowledge, opinions and attitudes about GDs were questioned. The prescribing percentage of GDs overall was also examined.Results: The survey was completed by 305 PCPs (mean age: 49.2 ± 7.9 years; 57.4% male). The rate of correct responses about GDs was 67.6% for basic knowledge and 46.6% for the development process. The percentages of PCPs who declared that GDs were 'less efficacious', 'of lower quality' and 'less safe' than original drugs were 65.2%, 53.4% and 35.4%, respectively. More than half (60.3%) of the PCPs declared not to pay attention to whether the drug is generic while prescribing. It was observed that, as the knowledge level of the physicians increased, negative opinions and prescribing attitudes regarding the effectiveness, quality and safety of the GDs decreased. The rate of GD prescribing (51.6%) in Izmir was lower than the rest of the country (54.6%; P < 0.001).Conclusion: This study shows that the knowledge of PCPs about GDs is generally inadequate, which reflects negatively on their opinions and attitudes regarding the use of GDs. Educational activities can help establish awareness that GDs can be used without doubt of their effectiveness, quality and safety

Antibiotic overconsumption and resistance in Turkey

WOS: 000468097700002PubMed ID: 30844434The latest report of the OECD Health Policy Studies stated that in2015 the highest rates of antimicrobial resistance (around 35% inTurkey, Korea and Greece) were seven times higher than the lowestrates among its member countries. As the OECD country with thehighest rate of resistance (38.8%), despite a 15-year hospital anti-biotic restriction programme, Turkey is in urgent need of revisingits policies and drawing an effective action plan to reverse thecurrent trend. In this commentary we review previous measurestaken to tackle antimicrobial overuse and resistance in Turkey and discuss their effectiveness

Attention Deficit Hyperactivity Disorder Treatment Practice in Turkey

Objective: To determine the factors associated with type of ADHD prescription and re-admission of the cases to the outpatient clinics between January-July 2013. Method: The Ministry of Health prescription database, which included prescriber, region, age and gender data and contained almost 20% of IMS data. Results: A total of 73,189 prescription were prescribed to a total of 41,341 (30,014 males; 72.7%) patients. 38645 (93.5%) of the patients were between 6 and 18 years of age. The most frequently prescribed drug was OROS methylphenidate (MPH, 59.7%) followed by IR MPH, atomoxetine and combination of drugs. There were several regional differences in prescription practice. Treatment choice changed significantly with age and gender. Rate of repeated prescription was highest among 6-18 year-old male subjects receiving combination treatment. Conclusions: ADHD treatment choice seemed to be heavily influenced by official regulations. Age, gender and drug of choice were important factors associated with treatment adherenc