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Decreasing outpatient antibiotic prescribing in Germany, 1995–2004, does not include newer macrolides, fluoroquinolones and extended-spectrum beta-lactams

Abstract number: p1464

Kern  W.V., With  K., Nink  K., Schröder  H.

Objective: 

The ESAC (European Surveillance of Antibiotic Consumption, http://www.ua.ac.be/ESAC) project has shown that outpatient antibiotic prescribing in Germany has been comparatively low among European countries. We assessed trends over time and regional variation of outpatient antibiotic use in Germany, and wondered if the observable decreasing trend included all drug classes to a similar extent.

Methods: 

Prescription data (compulsory health insurance covering >90% of the population, sample of 0.4% until the year 2000, all prescriptions thereafter) were analysed using the ATC/WHO methodology and current DDD definitions. We specifically defined the following drug groups: "basic" penicillins (BPENs, oral penicillin or aminopenicillins), extended-spectrum betalactams (ESBLs, oral cephalosporins, staphylococcal penicillins, aminopenicillin/betalactamse inhibitor combinations, parenteral cephalosporins and broad-spectrum betalactams), newer macrolides (NMLs, roxithromycin, clarithromycin, azithromycin) versus older macrolides (OMLs). Quinolones (FQs), folate synthesis inhibitors (T/Ss) and tetracyclines (TETs) were also assessed. Data were expressed in yearly DDD/1000 persons covered by the insurance (DDD/1000).

Findings: 

Outpatient prescribing in 1995 was 6140 DDD/1000 (corresponding to 16.8 DID = DDD/1000 and day) and decreased to 5430 DDD/1000 in the year 2000 and to 4672 DDD/1000 in 2004. The decreasing trend over the last 4 years was observed in all regions. The decrease was most significant for OMLs (-55%), T/Ss (-48%), TETs (-36%), and BPENs (-13%) while there was no decreasing use of ESBLs (±0%) and increases in the rate of prescribing NMLs (+13%) and FQs (+43%). TETs and BPENs, however remained the most prescribed antibiotics in 2004. Regional variations in 2004 remained large for BPENs (>3-fold) with very low prescribing rates in the Eastern region, but were small for T/Ss, NMLs and FQs (<2-fold).

Conclusions: 

Over a decade we observed a 24% decreasing outpatient antibiotic prescribing that included relevant antibiotic drug classes except ESBLs, NMLs and FQs. The relative increase was most significant for FQs.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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