JAC Advance Access originally published online on November 1, 2002
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Journal of Antimicrobial Chemotherapy (2002) 50, 989-997
© 2002 The British Society for Antimicrobial Chemotherapy
Antibiotic prescribing in general practice: striking differences between Italy (Ravenna) and Denmark (Funen)
1 Interuniversity Research Centre on Pharmacoepidemiology, Department of Pharmacology, University of Bologna, Via Irnerio 48, I-40126 Bologna, Italy; 2 Research Unit of General Practice and Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark; 3 Division of Clinical Pharmacology, Karolinska Institutet, WHO Collaborating Center for Drug Utilization Research and Clinical Pharmacological Services, Huddinge University Hospital, SE-141 86 Stockholm, Sweden
Received 24 May 2002; returned 16 July 2002; revised 30 July 2002; accepted 6 September 2002
Objective: To compare antibiotic prescribing in primary care in two European populations, one in Denmark (Funen), the other in Italy (Ravenna).
Methods: Reimbursement data (1999) were retrieved from the Odense Pharmacoepidemiologic Database (Denmark) and the Emilia Romagna Health Authority Database (Italy). The extent of antibiotic use (ATC J01) was analysed as the number of defined daily doses per 1000 inhabitants per day (DDD/1000 inhabitants/day), and as annual prevalence of use. A qualitative analysis was carried out according to the Drug Utilization 90% (DU90%) approach.
Results: Antibiotic consumption was 16.5 DDD/1000 inhabitants/day in Ravenna and 10.4 DDD/1000 inhabitants/day in Funen; the annual prevalence of use was 40 and 30 subjects/100 inhabitants, respectively. Italian children received a greater amount (four-fold in DDDs) of antibiotics than Danish ones, whereas consumption was only slightly higher in Italy than in Denmark in the other age groups. In Italy, injectable antibiotics (third generation cephalosporins or aminoglycosides) accounted for 4% of total DDDs and 11% of exposed subjects. In Funen, use of injectable antibiotics was negligible. The bulk of prescription (90% of total DDDs) was made up of eight (out of 38) different antibiotics in Denmark, mainly narrow-spectrum penicillins and macrolides (1st: phenoxymethylpenicillin), and of 18 (out of 74) antibiotics in Italy, mainly broad-spectrum penicillins, macrolides, fluoroquinolones and cephalosporins.
Conclusions: These data show remarkable differences in antibiotic prescribing between Italy and Denmark, and suggest possible overuse and misuse of antibiotics in Italy.
Keywords: drug utilization, general practice, antibiotic prescription, international comparison
* Corresponding author. Tel: +39-051-248526; Fax: +39-051-248862; E-mail: vaccheri{at}biocfarm.unibo.it
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