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JAC Advance Access published online on April 8, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki098
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Received November 24, 2004
Revised February 17, 2005
Accepted February 20, 2005

Original article

Analysis of the causes and consequences of decreased antibiotic consumption over the last 5 years in Slovenia

M. Cizman 1*, T. Srovin 1, M. Pokorn 1, S. Cad Pecar 2, and S. Battelino 3

1 University Medical Centre, Department of Infectious Diseases, Japljeva 2, 1525 Ljubljana, Slovenia
2 Institute of Public Health of the Republic of Slovenia, Trubarjeva 2, 1000 Ljubljana, Slovenia
3 University Medical Centre, Department of Otorhinolaryngology, Zaloska, 1525 Ljubljana, Slovenia

* To whom correspondence should be addressed.
M. Cizman, E-mail: milan.cizman{at}mf.uni-lj.si


  Abstract

Objectives:: Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.

Methods:: The data on outpatient antibiotic consumption were obtained from the Institute of Public Health and Health Insurance Institute of Slovenia and expressed in defined daily doses (DDD)/1000 inhabitant-days. The number of media publications on ‘antibiotic drugs’ and ‘bacterial resistance’ during the study period was obtained. In 2000, the prescription of co-amoxiclav and fluoroquinolones was restricted because of a constant increase in the consumption of these drugs. The data on incidence of acute mastoiditis and penicillin resistance among invasive pneumococci were obtained.

Results:: The total outpatient consumption of antibacterials increased from 15.21 DDD/1000 inhabitant-days in 1996 to 20.08 in 1999, and decreased to 16.97 in 2003. The consumption of restricted antibiotics decreased from 7.29 in 1999 to 5.25 DDD/1000 inhabitant-days in 2003. There was a positive correlation between antibiotic consumption and the number of newspaper articles (r=0.92), and a negative correlation between the number of diagnostic tests and antibiotic consumption (r=-0.73 for the C-reactive protein test and -0.68 for the streptococcal antigen detection test). Reduced antibiotic consumption was paralleled by a decrease in penicillin resistance among invasive pneumococci. No increase in mastoiditis cases was observed in spite of reduced antibiotic consumption.

Conclusion:: Restriction of antibiotic prescription proved to be effective in reducing outpatient antibiotic consumption. The effect was prolonged and affected restricted antibiotics as well as non-restricted drugs.

Keywords: antibiotic prescribing; bacterial resistance; interventions.
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