ArticleThe Journal of antimicrobial chemotherapy2014
Appropriate international measures for outpatient antibiotic prescribing and consumption: recommendations from a national data comparison of different measures.
Article in The Journal of antimicrobial chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors contributing to the variation in antibiotic prescribing among primary health care physicians: a systematic review.BMC primary care · 2024Pooled it
- Metrics to assess the quantity of antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure.The Journal of antimicrobial chemotherapy · 2018Pooled it
- Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- Identifying General Practitioners' Antibiotic Prescribing Profiles Based on National Health Reimbursement Data.Open forum infectious diseases · 2024Article
- Regional Variations in Outpatient Antibiotic Prescribing in Germany: A Small Area Analysis Based on Claims Data.Antibiotics (Basel, Switzerland) · 2022Article
- Nationwide implementation of online communication skills training to reduce overprescribing of antibiotics: a stepped-wedge cluster randomized trial in general practice.JAC-antimicrobial resistance · 2022Article
- Change-points in antibiotic consumption in the community, European Union/European Economic Area, 1997-2017.The Journal of antimicrobial chemotherapy · 2021Review
- Assessment of quarter billion primary care prescriptions from a nationwide antimicrobial stewardship program.Scientific reports · 2021Article
- Primary antibiotic resistance of Helicobacter pylori isolates is twofold more frequent in HIV-positive than HIV-negative individuals: A descriptive observational study.MicrobiologyOpen · 2021Observational
- The Decline in Outpatient Antibiotic Use.Deutsches Arzteblatt international · 2020Article
- Assignment of Canadian Defined Daily Doses and Canadian Defined Course Doses for Quantification of Antimicrobial Usage in Cattle.Frontiers in veterinary science · 2020Article
- Patient-related factors, antibiotic prescribing and antimicrobial resistance of the commensal Staphylococcus aureus and Streptococcus pneumoniae in a healthy population - Hungarian results of the APRES study.BMC infectious diseases · 2019Article
- Previous antibiotic exposure and antibiotic resistance of commensal Staphylococcus aureus in Spanish primary care.The European journal of general practice · 2018Article
- Antimicrobial Medicines Consumption in Eastern Europeand Central Asia - An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action.Frontiers in pharmacology · 2018Article
- Antibiotic consumption and resistance of gram-negative pathogens (collateral damage).GMS infectious diseases · 2018Review
- Antimicrobial Consumption and Susceptibility ofFrontiers in medicine · 2018Article
- Comparing antibiotic consumption between two European countries: are packages an adequate surrogate for prescriptions?Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2017Article
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- The global threat of antimicrobial resistance: science for intervention.New microbes and new infections · 2015Review
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesMany European countries have engaged in awareness campaigns to decrease outpatient antibiotic use and several measures have been proposed, e.g. the number of defined daily doses (DDDs) or packages per 1000 inhabitants per day, producing conflicting findings. Therefore, we set out to explore what measure is most appropriate.
methodsOutpatient data on each dispensed and reimbursed medicinal package in Belgium between 2002 and 2009 were aggregated at the level of the active substance in accordance with the Anatomical Therapeutic Chemical classification and expressed as the numbers of DDDs (WHO, version 2010), packages, treatments and insured individuals per 1000 inhabitants, insured individuals and patient contacts, per day, and in July-June years. Using these measures, time trends of outpatient antibiotic use were compared and explored in detail.
resultsExpressed per 1000 inhabitants per day, outpatient antibiotic use increased between 2002-03 and 2008-09 in DDDs, whereas in packages, treatments and insured individuals it decreased. The same was true for use expressed per 1000 insured individuals or when allowing for the decreasing number of patient contacts. Increasing numbers of DDDs per package (more items per package and higher doses per unit for amoxicillin and co-amoxiclav) explain these discrepancies.
conclusionsThe number of packages is a more appropriate measure than the number of DDDs when assessing outpatient antibiotic use over time and the impact of awareness campaigns in countries dispensing 'complete packages'. We recommended the use of different complementary measures or caution when interpreting trends based only on DDDs.
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