Monitoring the community use of antibiotics in Italy within the National Action Plan on antimicrobial resistance

Abstract

Background In Italy both the consumption of antibiotics and the prevalence of bacterial resistance are higher than in other European countries. In 2017, the first National Action Plan on Antimicrobial Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two national reports on antibiotic use in the human setting have been published. This article's aim is to describe the pattern of antibiotic consumption in the community setting in Italy from 2013 to 2018. Methods To analyse the consumption for reimbursed antibiotics dispensed by community pharmacies different data sources were used. Consumption was measured in terms of defined daily dose (DDD), prescriptions or prevalence of use. Results In 2018, the consumption of antibiotics in Italy amounted to 16.1 DDD per 1000 inhabitants per day. The rates of consumption by geographical area were: 12.7 DDD in the north, 16.9 in the centre and 20.4 in the south. The use was greater in the extreme age groups than in the population aged from 20 to 64 years. The consumption was higher in winter season, with high peaks in the incidence of flu syndromes. In the paediatric population, a utilization rate of 1010 prescriptions per 1000 children, with a prevalence of use of 40.8%, was found. Conclusion The study provides useful information on the geographical variability of antibiotic use in Italy to guide decision makers in the introduction of tailored interventions, as suggested by PNCAR, aimed at promoting a more rational use of antibiotics for humans and reducing antimicrobial resistance.

Using Belgian pharmacy dispensing data to assess antibiotic use for children in ambulatory care

“…These viral respiratory tract infections may lead to a secondary bacterial infection such as pneumonia or otitis media where an antibiotic is often justified [ 2 ]. An Italian study observed the same seasonality pattern of prescriptions, which was shown to be in parallel with the trend of flu syndromes [ 31 ].…”

“…As a consequence, the price of the original specialities must lower to compete with the generics [ 29 ], suppressing NIHDI expenditures. An overall decreasing trend in antibiotic use and expenditures has been observed for other high-income countries, such as France [ 30 ], Italy [ 31 ], Germany [ 32 ], and the Netherlands [ 32 ].…”

“…Similar to other high-income countries [ 30 , 31 , 33 , 34 ], penicillins are in general the most commonly prescribed antibiotics for children. Alternations in prescribing guidelines, which is often a consequence of antimicrobial resistance and/or side effects [ 35 ], drug shortages, and the rising co-payment of the patient for certain drug classes [ 25 ] presumably result in shifts in use of the different antibiotic classes.…”

Place in Therapy of the Newly Available Armamentarium for Multi-Drug-Resistant Gram-Negative Pathogens: Proposal of a Prescription Algorithm

“…This burden is mostly healthcare-associated and comparable to the cumulative effect of influenza, tuberculosis and HIV [ 4 ]. After the adoption in 2017 of the National Action Plan on Antimicrobial Resistance (PNCAR), Italian antibiotic consumption is now slowly decreasing, although with regional discrepancies and an overall utilization still higher than the European average [ 5 ]. National plans are probably not enough, and some experts are now demanding a decisive intervention of the European Parliament in a similar manner to that successfully used to fight air pollution [ 6 ].…”

Trend of Antibiotic Use in Children with Acute Otitis Media in Korea

“… 6 In Italy, the consumption of antibiotics has decreased from 18.4 daily defined dose (DDD) in 2013 to 16.1 DDD in 2018 following adopting NAP-AMR. 7 In line with South Korean NAP-AMR, the HIRA has been conducting annual review on the antibiotic prescription data of all insurers. 8 Assessment on the appropriateness of antibiotics use is made based on pediatric AOM guideline, which was developed in 2010.…”