Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands
Received 17 March 2003; returned 2 June 2003; revised 27 June 2003; accepted 12 July 2003
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Abstract |
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Methods: We assessed the volume of Dutch outpatient antibiotic prescriptions from 1992 to 2001 by calculating the mean number of outpatient antibiotic prescriptions (indicating the number of times physicians decide to prescribe an antibiotic agent) per 1000 patients insured by the Dutch Sickness Fund per year, according to subgroups (narrow-spectrum penicillins, broad-spectrum penicillins, tetracyclines, macrolides, sulphonamides and trimethoprim, and quinolones). Data were obtained from the Dutch Drug Information Project/Health Care Insurance Board.
Results: The total volume of outpatient antibiotic prescriptions in 2001 was 394 prescriptions per 1000 patients insured by the Dutch Sickness Fund. Overall, the rates were stable between 1992 and 2001, with small variations across years, but with marked differences in volumes within antibiotic groups across these years: a decrease in prescribing of narrow-spectrum penicillins (29%), amoxicillin (23%), tetracycline (24%), doxycycline (19%) and trimethoprim and derivatives (45%) was accompanied by an increase in prescribing of co-amoxiclav (+85%), macrolides (+110%) and quinolones (+86%).
Conclusions: The international trend of a decline in the use of narrow-spectrum and older penicillins and prescribing more broad-spectrum and new chemotherapeutics was shown to exist in a low prescribing country, The Netherlands. Therefore, inappropriate antibiotic prescribing should remain prominent on the research agenda in intervention studies in order to improve the appropriate selection of antibiotic class and to reduce the prescription of antibiotics.
Keywords: antibiotic prescription, broader-spectrum antibiotics, newer antibiotics, general practice, The Netherlands
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Introduction |
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Materials and methods |
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Results |
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Discussion |
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The decrease in the use of narrow-spectrum penicillins and the increasing use of co-amoxiclav, macrolides and quinolones indicates that the international trend of declining use of narrower spectrum and older penicillins and of prescribing more broad-spectrum and new chemotherapeutics8,11 is also present in a low prescribing country, i.e. The Netherlands, among GPs as well as medical specialists. The increase in the prescription of co-amoxiclav, macrolides and quinolones is noteworthy, because these drugs are seldomly first-choice treatments in Dutch national guidelines for respiratory and urinary tract cases in primary care, and the resistance patterns in The Netherlands do not justify their use as a first choice of drug.
The reasons for these trends are unknown. However, recently, pharmaceutical marketing activities in The Netherlands relating to 11 therapeutic markets have been shown to make doctors less sensitive to costs and quality in prescribing drugs, and to reduce the choice of competing drugs.12 This finding might explain the increase of newer (i.e. broader spectrum) antibiotics, like macrolides, to the detriment of older (i.e. narrower spectrum) antibiotics. Such a trend is unwanted, because growing use of newer and broader spectrum drugs like macrolides has been accompanied by growing resistance of important pathogens like Streptococcus pneumoniae and Helicobacter pylori to macrolides in The Netherlands.13,14
More emphasis on implementation of guidelines aimed at prescribing narrower spectrum and older penicillins in respiratory tract infections and especially lower respiratory tract infections seems to be needed, in addition to developing and implementing specific consultation strategies to promote more appropriate use of antibiotics in primary care.15 Inappropriate antibiotic prescribing should therefore remain prominent on the research agenda, aiming at intervention studies to improve the appropriate selection of antibiotic class and to reduce the prescription of antibiotics, as well as studies to identify patients at greater risk of complications or a long-lasting disease course.16,17
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Acknowledgements |
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Footnotes |
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References |
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