Stimac D, Vukusić I, Culig J
Zagreb Institute of Public Health, Mirogojska cesta 16, 10000, Zagreb, Croatia.
Pharm World Sci. 2005 Jun;27(3):230-5. doi: 10.1007/s11096-004-3704-z.
The aim was to estimate the outpatient utilization of antibacterials for systemic use in Zagreb, Croatia, and to define the antibiotic utilization characteristics and consequences.
Using the WHO ATC/DDD methodology, the number of defined daily doses per 1000 inhabitants per day (DDDs/TID) was calculated for each individual antibiotic and ATC system levels were calculated from data collected on the number and size of packages prescribed and dispensed from pharmacies. The Drug Utilization 90% (DU90%) method was used to evaluate the quality of drug prescribing.
The total utilization of antibiotics was found to be extremely high, 55.0 DDDs/TID. The leading antibiotic was amoxicillin + clavulanic acid with 14.7 DDDs/TID. Penicillins accounted for the highest utilization (46.3%) expressed in DDDs/TID (25.4), followed by cephalosporins and macrolides 25 and 12.5% of utilization, respectively expressed in DDDs/TID), tetracyclines, quinolones, aminoglycosides and other agents. Nine of 27 antibiotics fell within the DU90% segment. The cost/DDD foldrugs within DU90% segment was 1.2 EUR, for drugs beyond DU90% segment was 1.4 EUR, and the average was 1.2 EUR.
Irrational prescribing and preference to more expensive drugs have been reported in Zagreb. Therefore, the risk of resistance of microorganisms to beta-lactamase antibiotics, macrolides and quinolones could be expected. Prescribing patterns should be changed by introducing national guidelines on rational antibiotic prescribing, monitoring and evaluation of their implementation. Additional continuing education of physicians and pharmacists from independent sources should be organized and proper education should be provided to patients.
旨在评估克罗地亚萨格勒布全身用抗菌药物的门诊使用情况，并确定抗生素使用特征及后果。
采用世界卫生组织解剖学治疗学及化学分类系统/限定日剂量（WHO ATC/DDD）方法，计算每种抗生素的每日每千居民限定日剂量数（DDDs/TID），并根据药房处方和调配的药品包装数量及规格数据计算 ATC 系统级别。采用药物利用 90%（DU90%）方法评估药物处方质量。
发现抗生素总使用量极高，为 55.0 DDDs/TID。主要抗生素为阿莫西林+克拉维酸，用量为 14.7 DDDs/TID。以 DDDs/TID 表示，青霉素类的使用量最高（46.3%，即 25.4 DDDs/TID），其次是头孢菌素类和大环内酯类，分别占使用量的 25%和 12.5%（以 DDDs/TID 表示），还有四环素类、喹诺酮类、氨基糖苷类及其他药物。27 种抗生素中有 9 种落在 DU90%区间内。DU90%区间内药物的成本/DDD 为 1.2 欧元，超出 DU90%区间的药物为 1.4 欧元，平均为 1.2 欧元。
据报道，萨格勒布存在不合理用药及偏好使用更昂贵药物的情况。因此，可以预期微生物对β-内酰胺酶抗生素、大环内酯类和喹诺酮类产生耐药性的风险。应通过引入合理抗生素处方的国家指南、监测和评估其实施情况来改变处方模式。应组织来自独立来源的医生和药剂师进行额外的继续教育，并向患者提供适当的教育。
