Cangini Agnese, Gagliotti Carlo, Fortinguerra Filomena, Da Cas Roberto, Villa Federico, Trotta Maria Paola, Moro Maria Luisa, Trotta Francesco
Ufficio Monitoraggio della Spesa Farmaceutica e Rapporti con le Regioni, Agenzia Italiana del Farmaco.
Agenzia Sanitaria e Sociale Regionale Regione Emilia-Romagna.
Recenti Prog Med. 2020 Jan;111(1):13-29. doi: 10.1701/3294.32650.
Antimicrobial resistance is a major global public health concern. In Italy, in 2017, the National Plan to Fight Antimicrobial Resistance (PNCAR 2017-2020) was approved, in line with the Global One Health Action Plan. Despite the decreasing trend, the consumption of antibiotics in Italy continues to be higher than the European average, with a great variability between regions. In the European investigation on the distribution of resistant bacteria in Europe, Italy holds together with Greece the record for the spread of resistant germs.
The present study, dedicated to antibiotics for human use, allows to monitor the trend of consumption and expenditure in Italy and at the same time to identify areas of potential inappropriateness of use.
The analyses presented concern the use of antibiotics in the community setting, with a focus on consumption in the paediatric population and on the prescription of fluoroquinolones in specific population subgroups. In addition, the analysis on the use of antibiotics in hospital settings, the analysis on the private purchase of reimbursed antibiotics and the evaluation of indicators of appropriateness of antibiotic prescribing were also included. The analyses are based on the reading and integration of the data collected through different administrative healthcare databases: OsMed, Purchase by public health facilities, Direct distribution, Hospital consumption, Monitoring of pharmaceutical prescriptions, Private purchase by citizens, Hospital Discharge Records (Schede di Dimissione Ospedaliera, SDO), InfluNet surveillance.
The consumption of antibiotics in Italy in 2018 stood at 21.4 DDD/1000 ab. die and, despite the downward trend, is still above the European average. In terms of consumption within the territory (community setting), there is a considerable regional variety - ranging from 8.9 of the provincial government of Bolzano to 23.4 DDD/1000 ab. die of Campania (national average 16.1 DDD) - with higher values in the South and the Islands and lower in the North. The differences in drug use concern not only the number of prescriptions but also the type of antibiotics prescribed (type of molecules; broad spectrum vs. narrow spectrum). The association amoxicillin/clavulanic acid is the most widely used antibiotic both in the community and in hospitals. In the paediatric population (0-13 years) there is a peak prevalence of use of 50% in the first year of life of the child, with no differences between males and females. The consumption of antibiotics in hospitals is increasing in the three-year period 2016-2018 and presents a wide variability between different geographical areas.
抗菌药物耐药性是全球主要的公共卫生问题。2017年，意大利批准了《抗击抗菌药物耐药性国家计划（2017 - 2020年）》，与《全球一体化健康行动计划》保持一致。尽管呈下降趋势，但意大利的抗生素消费量仍高于欧洲平均水平，各地区之间差异很大。在欧洲关于耐药菌分布的调查中，意大利与希腊并列耐药菌传播记录榜首。
本研究专注于人类使用的抗生素，旨在监测意大利的消费和支出趋势，同时确定潜在的使用不当领域。
所呈现的分析涉及社区环境中抗生素的使用，重点关注儿科人群的消费以及特定人群亚组中氟喹诺酮类药物的处方情况。此外，还包括医院环境中抗生素使用情况的分析、报销抗生素的私人购买情况分析以及抗生素处方适宜性指标的评估。这些分析基于对通过不同行政医疗数据库收集的数据的读取和整合：OsMed、公共卫生设施采购、直接配送、医院消费、药品处方监测、公民私人购买、医院出院记录（Schede di Dimissione Ospedaliera，SDO）、InfluNet监测。
2018年意大利抗生素消费量为21.4限定日剂量/1000人·日，尽管呈下降趋势，但仍高于欧洲平均水平。在国内（社区环境）消费方面，存在相当大的地区差异——从博尔扎诺省政府的8.9到坎帕尼亚的23.4限定日剂量/1000人·日（全国平均16.1限定日剂量）——南部和岛屿地区数值较高，北部较低。药物使用差异不仅涉及处方数量，还涉及所开抗生素的类型（分子类型；广谱与窄谱）。阿莫西林/克拉维酸组合是社区和医院中使用最广泛的抗生素。在儿科人群（0 - 13岁）中，儿童出生第一年的使用患病率峰值为50%，男女之间无差异。2016 - 2018年的三年间，医院抗生素消费量呈上升趋势，不同地理区域之间差异很大。
