Antimicrobial drug use in hospitals in the Netherlands, Germany and Belgium

Abstract

Data on the use of antimicrobial drugs was collected by means of an inquiry to 30 hospitals in Belgium (15 in Dutch sectors and 15 in the French sectors), 21 hospitals in Germany and 20 hospitals in the Netherlands. The use of these drugs was expressed as the number of defined daily doses (DDD) per 100 bed days by the anatomical therapeutical chemical classification system. The total use of antimicrobial agents was significantly (p < 0.001) higher in both parts of Belgium (55.6 and 52.0 DDD per 100 bed days) than in Germany (37.9 DDD) or the Netherlands (34.1 DDD). In particular, amoxicillin-clavulanic acid, the first- and second-generation cephalosporins, aminoglycosides and fluoroquinolones were used more in Belgium than in either of the other countries. At least part of the differences observed in antimicrobial drug use could be explained by differences in written antibiotic policy.

Trends in Antibiotic Use at a University Hospital: Defined or Prescribed Daily Doses? Patient Days or Admissions as Denominator?

“…The differences between DDD/100 patient days and PDD/100 patient days were in part related to an intensive use in this hospital of amoxicillin-clavulanic acid, in particular at a daily dose of 2.2 parenterally every 8 h. As already noted earlier [10], the DDD for amoxicillin-clavulanic acid as defined in the ATC/WHO index is only 1 g per day, which is associated with a substantial overestimation not only of the true use of this drug, but also of all beta-lactams or overall antibacterials. For example, intravenous amoxicillin-clavulanic acid use in the year 2000 in the medical service was 31.9 DDD/100 patient days, but only 6.4 PDD/100 patient days when 6.6 g (which was the standard prescribed dose in this hospital) was the PDD definition, which would result in substantially different values for overall beta-lactam use in the medical service: 66.4 DDD/100 patient days versus 25.7 PDD/100 patient days, accordingly.…”

“…In other studies hospital pharmacy databases or computerized inpatient drug prescription records were used to indicate the "tonnage" of specific drugs or drug expenditures per time period or per beds, bed days or admissions for a specific time period. An increasing number of studies have used quantitation by defined daily doses (DDD) as recommended by the World Health Organization (WHO) collaborating Center for Drug Statistics Methodology (in the Anatomical Therapeutic Chemical [ATC]/WHO index) related to 100 occupied bed days (or patient days) as denominator [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Implementation of an educational program and an antibiotic order form to optimize quality of antimicrobial drug use in a department of internal medicine

“…Recently, national antimicrobial drug consumption data from European hospitals were published by Janknegt et al (4). Dutch university hospitals had a rather low consumption of antimi crobial drugs (44,3-46.6 defined daily doses per 100 bed days) compared with German and Belgian hospitals, which seems to be reflected by lower re sistance rates in the Netherlands.…”

Tendências na utilização de antimicrobianos em um hospital universitário, 1990-1996

“…7,13 Alguns estudos europeus relataram uma média de consumo entre 34,1 a 75,77 DDD por 100 leitos-dia, avaliando um total de 101 hospitais estudados. 3,8,9 Dados sobre o consumo em DDD em hospitais nacionais não estavam disponíveis na literatura quando da revisão. Sugere-se que o alto consumo de antimicrobianos aqui verificado deva-se a hábitos de prescrição, inadequada adesão a normas de uso apropriado, pouca experiência em programas de avaliação do uso de medicamentos 16 e à complexidade dos procedimentos hospitalares 6,15 realizados.…”