A cross‐national comparison was performed on paediatric (0‐19 years) antibiotic use in Hungary, Norway and Portugal to explore and compare the scale and pattern of paediatric antibiotic use in these three European countries. Ambulatory care systemic antibiotic use (ATC: J01) was retrieved from national databases for year 2014. The main outcome measure was number of antibacterial packages per child inhabitant per year (packages/child/year) and was further stratified by age groups. Paediatric antibiotic use peaked in Hungary with 1.3 packages/child/year, followed by Portugal (0.8) and Norway (0.3). This ranking was retained and was most prominent in the 5‐ to 9‐year and 10‐ to 14‐year age groups. The pattern of antibiotic use in different paediatric age groups varied also substantially between countries. Narrow‐spectrum penicillins were much commonly used in Norway in all paediatric age subgroups in comparison with Hungary and Portugal. Newer, broad‐spectrum cephalosporins and macrolides were widely prescribed for Hungarian and Portuguese children in all paediatric subgroups in contrast to Norway, while tetracyclines were commonly prescribed for Norwegian adolescents. The scale and pattern of paediatric antibiotic use in Hungary and Portugal were very different compared with Norway. The high antibiotic exposure and the high consumption of broad‐spectrum penicillins begin in childhood in Hungary and Portugal which underpins the responsibility of paediatric GPs.

Background: Lower urinary tract infections (LUTIs) are amongst the most common community acquired infections with frequent antibiotic prescribing. Objectives: To assess empiric antibiotic choice in different types of lower urinary tract infections. We also aimed to identify determinants of fluoroquinolone prescribing, as well as to determine the rate of short antibiotic courses. The frequencies of executing laboratory tests and recommending analgesics/anti-inflammatory drugs were also assessed. Methods: A prospective observational study was performed in 19 different Hungarian primary care practices. Participating general practitioners (GPs) filled out data sheets for each patient with a suspected urinary tract infection. Details of drug use were evaluated. Comparison of different LUTI groups were made by descriptive statistics and univariate analysis. Possible determinants of fluoroquinolone prescribing were assessed by logistic regression. Results: Data sheets of 372 patients were analyzed. The majority of patients (68.82%) had acute uncomplicated cystitis. While antibiotics were prescribed for almost every patient (uncomplicated cases: 92.58%, complicated cases: 94.83%), analgesics/antiinflammatory drugs were recommended at a rate of 7.81% in uncomplicated, and 13.79% in complicated cystitis cases. Ciprofloxacin was the most commonly prescribed antibacterial agent in both types of cystitis. Short-term antibiotic therapy was prescribed in one third of relevant cases. Logistic regression found a weak association between fluoroquinolone use and patient's age and presence of complicating factors. Conclusions: Many aspects of suboptimal cystitis management were identified (e.g. unnecessarily broad spectra agents, too long antibiotic courses). In this study, patient characteristics has weakly influenced fluoroquinolone prescribing. Based on these results there is considerable room for improvement in primary care antibiotic therapy of cystitis in Hungary.

Background: The elderly use antibiotics frequently due to their increasing infection susceptibility. Given the high and increasing proportion of elderly in the population, their antibiotic use is substantial. Objective: This study aimed to compare antibiotic use in the elderly in the ambulatory care sector between Hungary and Sweden.Methods: This retrospective, descriptive, cross-national, comparative study included antibacterial use data from the Hungarian National Health Insurance Fund and the Swedish eHealth Agency. Antibiotic use (anatomical therapeutical chemical: J01) was expressed as the number of prescriptions/1000 inhabitants/year or month and was further stratified by age and sex.Results: Antibiotic exposure was higher in the Hungarian elderly population (649.8 prescriptions/1000 inhabitants/year) compared to its Swedish counterparts (545.0 prescriptions/1000 inhabitants/year). Hungary had a similar scale of antibacterial exposure across all elderly age subgroups, with different trends in males and females, while Sweden had a stepwise increase in antibiotic exposure by age in both sexes. The seasonal fluctuation was high in Hungary and reached a peak of 80.7 prescriptions/1000 inhabitants/month in January 2017, while even antibiotic use was detected throughout the year in Sweden. The pattern of antibiotic use in the elderly considerably differed between the two countries. Penicillin and beta-lactamase combinations, such as co-amoxiclav, were more frequently used in Hungary than in Sweden (19.08% vs 1.83% of corresponding total ambulatory antibiotic use). Likewise, quinolones were more commonly used in Hungary than in Sweden (34.53% vs. 9.98). The elderly in Sweden were mostly prescribed narrow spectra penicillins (26.71% vs. 0.29% in Hungary).Conclusion: This cross-national comparison revealed important differences in all aspects of antibiotic use in the elderly between the two countries. The identical scale and pattern of antibiotic use cannot be anticipated due to the poorer health status of the Hungarian elderly population. However, the substantial differences indicate some room for improvement in the antibiotic prescription for the Hungarian elderly.

BackgroundAll antibiotics were categorised into access, watch and reserve groups in the latest List of Essential Medicines by the WHO.1 Antibiotics belonging to the reserve group should be protected and kept as a last resort when all others fail to give therapeutic effect.PurposeTo map the consumption of reserve class antibiotics during the past 5 years.Material and methodsThe study was done on reserve group antibiotics which were selected based on the WHO definition. National data, regarding distribution to hospitals, were collected from wholesales statistics for the period between 2012 and 2016. Additionally, regional consumption data for 2016 were collected. Antibiotic use was analysed according to the Anatomical Therapeutic Chemical – Defined Daily Dose method (version 2017) and expressed in DDD per 100 patient-days.ResultsDuring the study period an increase in the national use of reserve antibiotics from 0.13 to 0.26 DDD per 100 patient-days could be observed. This corresponds to a relative increase from 0.57% to 1.13% in the total use of antibiotics in the hospital. A noticeable increase in the use of colistine (from 0.09 to 0.19 DDD per 100 patient-days) and tigecycline (from 0.01 to 0.03 DDD per 100 patient-days) accounts for a great part of this upward trend. A huge variation in the regional use of reserve group antibiotics were also detected (mean: 0.26; min: 0.02; max: 1.08 DDD per 100 patient-days). Three out of four counties providing tertiary care were among the top consumers of these antibiotics.ConclusionThough the collected data is a crude measure, it shows a trend in the increase (roughly doubled) in the absolute and relative use of reserve antibiotics nationally. This trend could be explained by several factors, as an increase in antibiotic resistance and increased access of these drugs. The detected large regional variations require further research. Since these antibiotics belong to the last-line treatment options, tight monitoring is essential, to maintain their therapeutic value.Reference and/or Acknowledgements1. WHO Model List of Essential Medicines, 20th List, World Health Organisation, 2017.No conflict of interest