Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5, 960, 191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient''s average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally

Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012

Resumen: Introducción: El análisis del consumo de fármacos en grandes grupos poblacionales permite ver tendencias de consumo y comparar diferentes ámbitos. Objetivo: Analizar la tendencia temporal de consumo y costes de fármacos específicos para la demencia en la comunidad autónoma de Madrid (CAM) y comparar por grupos de edad y sexo. Métodos: Estudio descriptivo, seleccionando anticolinesterásicos (N06DA) y memantina (N06DX01) dispensados en la CAM del 2002 al 2012 con cargo al Sistema Nacional de Salud. El consumo se calculó analizando la evolución de las dosis diarias definidas (DDD), con incrementos totales y anuales. El coste se estimó por precio de DDD. Para comparar el consumo por edad y sexo, se calcularon las DDD por 100 habitantes-día. Resultados: Del 2002 al 2012 se multiplicó por 6 el consumo de fármacos para la demencia. El 76,70% de los fármacos consumidos en este periodo fueron anticolinesterásicos y el 23,30% memantina. La evolución del coste estimado se multiplicó por 5,7 en 11 años (por 4 considerando utilización de fármacos genéricos).En 2012, el 2,42% de los mayores de 65 años consumió anticolinesterásicos (2,82% mujeres, 1,83% hombres) y el 0,90% memantina (1,10% mujeres, 0,61% hombres). El consumo aumentó hasta los 86-90 años (5,84% en anticolinesterásicos; 2,33% en memantina), disminuyendo posteriormente. Conclusiones: El consumo de anticolinesterásicos y memantina aumentó progresivamente, sin alcanzar en 2012 cifras equivalentes a la prevalencia poblacional de demencia. Las medidas de contención de gasto farmacéutico pueden frenar el aumento del coste, aunque este volverá a crecer si persiste la misma tendencia temporal de consumo. Abstract: Introduction: Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. Objective: to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. Methods: Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. Results: Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs).In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. Conclusions: Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise. Palabras clave: Demencia, Anticolinesterásicos, Memantina, Farmacoepidemiología, Uso de fármacos, Coste, Keywords: Dementia, Cholinesterase inhibitors, Memantine, Pharmacoepidemiology, Drug utilization, Cos

Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012

Introduction: Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. Objective: To analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. Methods: Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. Results: Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs).In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. Conclusions: Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise. Resumen: Introducción: El análisis del consumo de fármacos en grandes grupos poblacionales permite ver tendencias de consumo y comparar diferentes ámbitos. Objetivo: Analizar la tendencia temporal de consumo y costes de fármacos específicos para la demencia en la comunidad autónoma de Madrid (CAM) y comparar por grupos de edad y sexo. Métodos: Estudio descriptivo, seleccionando anticolinesterásicos (N06DA) y memantina (N06DX01) dispensados en la CAM del 2002 al 2012 con cargo al Sistema Nacional de Salud. El consumo se calculó analizando la evolución de las dosis diarias definidas (DDD), con incrementos totales y anuales. El coste se estimó por precio de DDD. Para comparar el consumo por edad y sexo, se calcularon las DDD por 100 habitantes-día. Resultados: Del 2002 al 2012 se multiplicó por 6 el consumo de fármacos para la demencia. El 76,70% de los fármacos consumidos en este periodo fueron anticolinesterásicos y el 23,30% memantina. La evolución del coste estimado se multiplicó por 5,7 en 11 años (por 4 considerando utilización de fármacos genéricos).En 2012, el 2,42% de los mayores de 65 años consumió anticolinesterásicos (2,82% mujeres, 1,83% hombres) y el 0,90% memantina (1,10% mujeres, 0,61% hombres). El consumo aumentó hasta los 86-90 años (5,84% en anticolinesterásicos; 2,33% en memantina), disminuyendo posteriormente. Conclusiones: El consumo de anticolinesterásicos y memantina aumentó progresivamente, sin alcanzar en 2012 cifras equivalentes a la prevalencia poblacional de demencia. Las medidas de contención de gasto farmacéutico pueden frenar el aumento del coste, aunque este volverá a crecer si persiste la misma tendencia temporal de consumo. Keywords: Dementia, Cholinesterase inhibitors, Memantine, Pharmacoepidemiology, Drug utilization, Cost, Palabras clave: Demencia, Anticolinesterásicos, Memantina, Farmacoepidemiología, Uso de fármacos, Cost