ArticleZdravstveno varstvo2018
Outpatient Antibiotic Consumption for Urinary Infections in Croatia 2005 - 2014: What can be Learned from Utilization Trends.
Article in Zdravstveno varstvo, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis.Croatian medical journal · 2023Article
- How effective is a brief educational intervention on prescribing first-line antibiotics in acute cystitis? A quasi-experimental study among general practitioners in Croatia.Croatian medical journal · 2022Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimThe aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014, to describe utilisation trends, and general consequences of antibiotic consumption on antimicrobial resistance.
methodsAntibiotic utilisation data were obtained from annual reports of both the Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID). Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Descriptive statistics were used to process data and calculate trends.
resultsOverall, utilisation of antibacterials decreased by 4.8% (from 3,35 to 3,19 DDD TID), while trends of individual agents varied substantially - from 87% decline for ceftibuten to 160% rise for levofloxacin. The consumption of quinolones increased by 32.3%. This was mostly due to increased ciprofloxacin consumption (144% raise). Sulfamethoxazole-trimethoprim declined by 57%, while nitrofurantoin increased by 86%. The use of fosfomycin was marginal. Antimicrobial resistance of E. coli increased against quinolones by 54.5%, and against nitrofurantoin by 2-3%. Quinolone resistance of other pathogens (Klebiella spp, Proteus mirabilis), increased variably - between 17.2% (Klebsiella) and 90% (Proteus), while for P. aeruginosa remained the same at 22%.
conclusionHigh rates of antimicrobial utilisation require prescribing restrictions and educational interventions. The increased use of fluoroquinolones is a potentially serious public health threat due to the rapid development of resistance among uropathogens. This threat can be avoided by greater use of nitrofurantoin and fosfomycin.
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