Monitoring of antibiotic prescribing promotes rational use of drugs, reduces costs and slows down the development of resistance. Upper respiratory tract infections (URIs) are common conditions managed in primary health care (PHC). The aim of this study was to evaluate prescribing of antibiotics, especially in the treatment of URIs in PHC of Niš region and to identify the practice of drug overuse, underuse or inappropriate use. The data on outpatient use of antibacterials for systemic use was obtained by retrospective study and expressed as the number of defined daily doses (DDD) per 1000 inhabitants per day (DID), according to the WHO anatomic therapeutic chemical classification and DDD measurement methodology. The City Pharmacy Department provided automatic reports on antibiotics prescribed by physicians for certain diagnoses in the Niš region over the 2005-2007 period. In the same period, outpatient antibiotic use increased by 9.02% (22.83/ 25.96 DID). The most commonly prescribed drugs were semi-synthetics penicillins and macrolides. The greatest increase in antibiotics prescriptions was noted in azithromycin (by 164%). Out of the total number of antibiotics, 70.5% prescriptions were made for the treatment of URIs. Pharingitis acuta was the most common indication for prescription of antimicrobial medicines (45.26%). Amoxicillin (33%) and cephalexin (35%) were most commonly prescribed antibiotics for this indication. This analysis shows the irrational use of antibiotics in primary health care in the Niš region, which requires an additional application of educational programs and monitoring of microbial sensitivity. The results will be the basis for further evaluation of rational use of antibiotics in primary health care.
Akkerman AE, Wouden JC, Kuyvenhoven MM, Dieleman JP, Verheij TJ. Antibiotic prescribing for respiratory tract infections in Dutch primary care J Antimicrob Chemother. 2004;54(6):1116–21.
2.
Metz-Gercek S, Maieron A, Strauss R, Weininger P, Apfalter P, Mittermayer H. Ten years of antibiotic consumption in ambulatory care: trends in prescri bing practice and antibiotic resistance in Austria. BMC Infect Dis. 2009;13(9):61–5.
3.
Smeets HM, Kuyvenhoven MM, Akkerman AE, I W, Schouten GP, Essen GA, et al. Intervention with educational outreach at large scale to reduce antibiotics for respiratory tract infections: a controlled before and after study. Fam Pract. 2009;26(3):183–7.
4.
Ranji S, MA S, KG G, R. Interventions to reduce unnecessary antibiotic pres cribing: a systematic review and quantitative analy sis. Med Care. 2008;46(8):847–62.
5.
Wierzbowski AK, Hoban DJ, Hisanaga T, DeCorby M, Zhanel GG. The use of macrolides in treatment of upper espiratory tract infections. Curr Allergy Asthma Rep. 2006;6(2):171–81.
6.
Coenen S, Muller A, Adriaenssens N, V V, Hendrickx E, Goossens H, et al. European Surveillance of Atimicrobial Consu mtion (ESAC): outpatient parenteral antibiotic treat ment in Europe. J Antimicrob Chemother. 2009;64(1):200–5.
7.
Ferech M, Coenen S, Malhotra-Kumar S, Dvorakova K, Hendrickx E, Suetens C, et al. European Surveillance of Atimicrobial Consumtion (ESAC): outpatient antibiotic use in Eu rope. J Antimicrob Chemother. 2006;58(2):401–7.
8.
Butler CC, Hood K, Verheij T, Little P, Melbye H, Nuttall J, et al. Variation in antibiotic prescri bing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ. 2009;338:b2242.
9.
Gonzales R, Steiner JF, Sande MA. Antibiotic pres cribing for adults with colds, upper respiratory tract infections, and bronchititis by ambulatory care phy sicians JAMA. 1997;278(11):1–8.
10.
Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect. 2009;15(3):12–5.
11.
Roosmalen MS, JCC B, Smet PA, RP G. Antibiotic prescribing in primary care: first choice and restrictive prescribing are two different traits. Qual Saf Health Care. 2007;16(2):105–9.
12.
Akkerman AE, Kuyvenhoven MM, Wouden JC, Verheij TJ. Deteminants of antibiotic overpres cribing in respiratory tract infections in general pra ctice. J Antimicrob Chemother. 2005;56(5).
13.
Rutschmann OT, DominoME. Antibiotics for Upper Respiratory Tract Infections in Ambulatory practice in United States,1997-1999. Does Physician Specia lty Matter J Fam Pract. 2004;17:196–200.
14.
Goosens H, Ferech M, Vander Stichele R, Group EMESACP. Outpatients antibiotic use in Europe and association with resistance: a cross- national database study. Lancet. 2005;36:579–87.
15.
Stimac D, Vukušić I, Culig J. Outpatient use of sys temic antibiotics in Croatia. Pharm World Sci. 2005;27(3):230–5.
16.
W.H.O. ATC index with DDDs. World Health Organiza tion: World Health Organisation Collaborating Centre for Drug Statistics Methodology, 2003-2005.
17.
Duborija-Kovačević N. Antibiotic prescribing of the Republic Health Insurance Fund of Montenegro in the period 2000-2004: Effects of drug utilization reform strategy. Med Pregl. 2006;59(5–6):235–40.
18.
Majeed A.Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis. J R Soc Med. 2006;99(7):358–62.
19.
Spurling GK, Del Mar CB, Dooley L, Foxlee R. Dela yed antibiotics for symptoms and complications of respiratory infections. Cochrane Database Syst Rev. 2007;3):CD004417.
20.
Parmar DM, Jadav SP, Shah BK. Can azitromycin be substituted for amoxy cillin in upper respiratory tract infections. Indian J Pharm. 2007;39(1):55–6.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
