Lázaro Bengoa Edurne, Madurga Sanz Mariano, de Abajo Iglesias Francisco J
División de Farmacoepidemiología y Farmacovigilancia. Agencia Española del Medicamento. Madrid. Spain.
Med Clin (Barc). 2002 Apr 27;118(15):561-8. doi: 10.1016/s0025-7753(02)72453-6.
The purpose of this study was to analyse the trend in antibiotics consumption to draw on the National Health System (NHS) over the last 16 years in Spain and its different Autonomous Communities (AC).
Consumption data for all antibiotics used in Spain, either alone or in fixed-dose combinations, were obtained using the database ECOM. This database includes all the packages sold through retail pharmacies and reimbursed by the NHS. Data are expressed as defined dairy doses per 1,000 inhabitants per day (DHD), in accordance with the methodology recommended by the World Health Organization. Demographic data were provided by the National Institute of Statistics.
In 1985 the overall consumption of antibiotics was 21.9 DHD, while in 2000 it was 20.4 DHD. It was possible to distinguish three phases over the study period. The first phase lasts until 1989, where a mild decreasing trend was observed (1.1 DHD; 5.0%), mainly due to the fall of fixed-dose combinations of antibiotics and the association of sulfamethoxazole-trimethoprim. The second phase, lasting until 1996, was characterized by a generalized increase in the consumption in all AC, with an average of 2.3 DHD (+ 11.1%), ranging from 0.4 to 4.6 DHD; this increase was mainly due to the marketing of new macrolides, cephalosporins and quinolones. Finally, there was a third phase beginning in 1996, where the consumption of antibiotics came into a sustained and generalized decline, ranging from 0.5 to 5.1 DHD, and depending on the AC (national average 2.7 DHD, 11.7% lower than that in 1996). This latter trend was mainly due to the fall of wide-spectrum penicillins. Differences between AC regarding the level of consumption were huge over the study period, although the pattern of use was quite similar. There was, for instance, a difference of 10.4 DHD between Región de Murcia and Islas Baleares in 2000, or 9.9 DHD between the former and Madrid in the same year.
The consumption of antibiotics in Spain and all its AC has declined since 1996, probably related to the campaigns launched by public administrations to promote the rational use of these agents. The main subgroup involved in this trend is wide-spectrum penicillins. Differences in antibiotics use between AC are too big to be accounted for by different epidemic patterns and, therefore, should be analysed further.
本研究旨在分析过去16年西班牙及其不同自治区国家卫生系统（NHS）抗生素消费趋势。
使用ECOM数据库获取西班牙单独或固定剂量组合使用的所有抗生素的消费数据。该数据库包括通过零售药店销售并由NHS报销的所有药品包装。数据按照世界卫生组织推荐的方法，以每千居民每天规定日剂量（DHD）表示。人口统计数据由国家统计局提供。
1985年抗生素总消费量为21.9 DHD，而2000年为20.4 DHD。在研究期间可区分三个阶段。第一阶段持续到1989年，观察到轻微下降趋势（1.1 DHD；5.0%），主要是由于抗生素固定剂量组合以及磺胺甲恶唑 - 甲氧苄啶的关联使用量下降。第二阶段持续到1996年，其特征是所有自治区的消费量普遍增加，平均增加2.3 DHD（+11.1%），范围从0.4到4.6 DHD；这种增加主要是由于新大环内酯类、头孢菌素类和喹诺酮类药物的上市。最后，从1996年开始进入第三阶段，抗生素消费量持续普遍下降，范围从0.5到5.1 DHD，具体取决于自治区（全国平均2.7 DHD，比1996年低11.7%）。后一种趋势主要是由于广谱青霉素使用量下降。在研究期间，不同自治区之间的消费水平差异巨大，尽管使用模式相当相似。例如，2000年穆尔西亚地区和巴利阿里群岛之间相差10.4 DHD，同年该地区与马德里之间相差9.9 DHD。
自1996年以来，西班牙及其所有自治区的抗生素消费量有所下降，这可能与公共管理部门发起的促进合理使用这些药物的活动有关。参与这一趋势的主要亚组是广谱青霉素。不同自治区之间抗生素使用的差异太大，无法用不同的流行模式来解释，因此应进一步分析。
