Fürst Jurij, Čižman Milan, Mrak Jana, Kos Damjan, Campbell Stephen, Coenen Samuel, Gustafsson Lars L, Fürst Luka, Godman Brian
Health Insurance Institute of Slovenia, Miklošičeva 24, SI-1507 Ljubljana, Slovenia.
Expert Rev Anti Infect Ther. 2015 Feb;13(2):279-89. doi: 10.1586/14787210.2015.990381. Epub 2014 Dec 13.
Rising antibiotic resistance has become an increasing public health problem. There is a well-established correlation between antibiotic consumption and antimicrobial resistance. Consequently, measures to rationalize the prescribing of antibiotics should reduce the resistant strains. Following a 24% increase in antibiotic consumption at the end of the 1990s, multiple activities were designed and introduced by the Health Insurance Institute of Slovenia (ZZZS) and other organizations in Slovenia at the end of 1999. These activities reduced the antibiotic consumption by 18.7% by 2002. These measures have continued.
To study changes in antibiotic utilization from 1995 to 2012 alongside the multiple interventions and their consequences, including changes in resistance patterns.
This was a retrospective observational study involving all patients dispensed at least one ZZZS prescription for an antibiotic in Slovenia. Utilization was expressed in defined daily doses per thousand inhabitants per day. Multifaceted interventions were conducted over time involving all key stakeholder groups, that is, the Ministry of Health, ZZZS, physician groups and patients. These included comprehensive communication programs as well as prescribing restrictions for a number of antibiotics and classes.
From 1999 to 2012, antibiotic consumption decreased by 2-9% per year, with an overall decrease of 31%. There were also appreciable structural changes. Overall antibiotic utilization and the utilization of 7 out of 10 antibiotics significantly decreased after multiple interventions. The resistance of Streptococcus pneumoniae to penicillin decreased in line with decreased utilization. However, its resistance to macrolides increased from 5.4 to 21% despite halving of its utilization. The resistance of Escherichia coli to fluoroquinolones doubled from 10 to 21% despite utilization decreasing by a third. Expenditures on antibiotics decreased by 53%.
Multiple demand-side measures introduced following increased utilization significantly decreased subsequent antibiotic utilization and associated costs. However, there was variable impact on antibiotic resistance. Additional targeted activities are planned to further reduce antibiotic prescribing and resistance.
抗生素耐药性不断上升已成为日益严重的公共卫生问题。抗生素消费与抗菌药物耐药性之间存在既定的关联。因此，合理使用抗生素的措施应能减少耐药菌株。在20世纪90年代末抗生素消费增长24%之后，斯洛文尼亚健康保险协会（ZZZS）和斯洛文尼亚的其他组织于1999年底设计并开展了多项活动。到2002年，这些活动使抗生素消费减少了18.7%。这些措施一直在持续。
研究1995年至2012年期间抗生素使用情况的变化以及多项干预措施及其后果，包括耐药模式的变化。
这是一项回顾性观察研究，涉及斯洛文尼亚所有至少开具过一张ZZZS抗生素处方的患者。使用量以每千居民每天的限定日剂量表示。随着时间的推移，对所有关键利益相关者群体，即卫生部、ZZZS、医生群体和患者，开展了多方面的干预措施。这些措施包括全面的宣传项目以及对多种抗生素及类别进行处方限制。
从1999年到2012年，抗生素消费每年下降2% - 9%，总体下降了31%。也有明显的结构变化。经过多次干预后，总体抗生素使用量以及10种抗生素中的7种的使用量显著下降。肺炎链球菌对青霉素的耐药性随着使用量的减少而降低。然而，尽管其使用量减半，但其对大环内酯类药物的耐药性从5.4%增至21%。大肠杆菌对氟喹诺酮类药物的耐药性从10%增至21%，翻了一番，尽管使用量下降了三分之一。抗生素支出下降了53%。
在使用量增加后采取的多项需求侧措施显著降低了随后的抗生素使用量及相关成本。然而，对抗生素耐药性的影响各不相同。计划开展更多有针对性的活动，以进一步减少抗生素处方和耐药性。
