Are There Striking Differences in Outpatient Use of Antibiotics Between South Backa District, Serbia, and Some Scandinavian Countries?

Abstract

There is little published information about antibiotic utilization in outpatients in Serbia. The objective of this study was to determine the amount and structure of outpatient antibiotic use in South Backa District (SBD) in Serbia, to assess prescibing quality of antibiotics and to compare with results from Scandinavian countries. Data on the antibiotic use were collected from all private and state-owned pharmacies from January through March 2008 in SBD. Results were expressed as the number of defined daily doses/1,000 inhabitants/day. The drug utilization 90% method was also used. Penicillins were the most frequently used antibiotic subgroup in SBD (35.20%), followed by cephalosporins (19.16%) and macrolides (13.18%). Thirteen drugs accounted for 90% of total antibiotics consumption (DU90% segment). The average cost/DDD within the DU90% segment was 0.95 euros, whereas the average cost/DDD beyond the DU90% segment was 1.89 euros, indicating that less expensive antibiotics were more frequently used. High use of ampicillin, third-generation cefalosporins, co-trimoxazole, and gentamicin, will aggravate the alarming problem of resistance in Serbia. Differences in the amount and structure of antibiotic consumption between SBD and Scandinavian countries indicate the need of updated national guidelines for rational antimicrobial drug use in Serbia.

The antibiotic prescription practice in primary health care from the pharmacist perspective

“…In 2008 an antibiotic consumption study was performed in the South Backa District (SBD) and the obtained results were compared with antibiotic consumption in Finland and Denmark during the same period. Penicillins were the most commonly prescribed antibiotics in all three countries [24]. Th e most commonly prescribed antibiotics in Romania in 2008 were broad-spectrum penicillins, second-generation cephalosporins and fl uoroquinolones [25].…”

Knowledge, beliefs and habits of public university students from Southern Serbia regarding usage of antibiotics

“…Serbian households often keep antibiotics in home pharmacies (Paut Kusturica et al, 2015: 115) and over-prescription by physicians has occurred even after the completion of the campaign, notably in cases of acute bronchitis (Petrovic et al, 2019: 687). In addition, Serbia is among few European countries not participating in ESAC-Net (European Surveillance of Antimicrobial Consumption Network) (Horvat et al, 2018). This indicates a link between high antibiotic consumption and erroneous attitudes of the public, showing that further investigation of attitudes of the public is needed.…”

“…This is due to the scarce treatment of this subject in Serbia and poor pharmaceutical management. The country requires national guidelines on antibiotic use in the outpatient primary care (Horvat et al, 2018). Some information regarding the subject is available in the Serbian language only and as such is inaccessible to the international audience.…”

“…Inappropriate use practices include self-medication , missed purpose, short duration of treatment, inadequate dose, or stopping prematurely upon improvement of disease symptoms (Ocan et al, 2015). The percentage of self-medicating patients in Europe has grown in the past years from 5 per cent in 2009 to 7 per cent in 2016 (Lescure et al, 2018), ranging from 3 per cent in Northern Europe (Horvat et al, 2018) to the largest rates in countries of South-Eastern Europe. This includes 28 per cent in Slovenia and 20.5 per cent in Croatia, neighbouring countries to Serbia where this study was conducted (Grigoryan et al, 2010).…”

Extracorporeal Blood Purification in moderate and severe COVID-19 patients: a prospective cohort study

“…We detected bacterial co-infections more frequently in patients previously hospitalised at peripheral clinics compared to the sub-group admitted from home.Empirical antibiotics are administered for max 48hr or discontinued immediately following negative representative cultures[62]. It is possible that our AMR-protocol may be masked by unwarranted antibiotics administration elsewhere, a common clinical practice in south-eastern Europe[63][64][65][66].Clinically, the heterogeneity among the severe cases was striking; the clinical course of severe COVID-19, the extent of the affected lung area and development of ARDS was often not aligned with systemic levels of biomarkers. Several critical cases in need of mechanical ventilation and inotrope support showed clinical deterioration despite decreasing inflammatory mediators.A consistent observation in our study was the gradual decrease in SpO 2 in critical cases and the continuous high values of D-dimers, which may point to hypercoagulability, micro-embolism, leading to inadequate peripheral oxygen homeostasis.…”