Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database

Abstract

Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice.

Design: Retrospective cohort register-based study including the Danish National Prescription Register.

Setting: Population-based study of routine electronic antibiotic prescriptions from Danish general practice.

Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013).

Main outcome measures: Number of prescriptions per clinical indication. Number of antibiotic prescriptions per 1000 inhabitants by age and gender. Logistic regression analysis estimated the association between patient and provider factors and missing clinical indications on antibiotic prescriptions.

Results: A total of 2.381.083 systemic antibiotic prescriptions were issued by Danish general practitioners in the study period. We identified three main clinical entities: urinary tract infections (n = 506.634), respiratory tract infections (n = 456.354) and unspecified infections (n = 416.354). Women were more exposed to antibiotics than men. Antibiotic use was high in children under 5 years and even higher in elderly people. In 32% of the issued prescriptions, the clinical indication was missing. This was mainly associated with antibiotic types. We found that a prescription for a urinary tract agent without a specific clinical indication was uncommon.

Conclusion: Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable.

Keywords:

• Antibiotic prescribing
• clinical indication
• general practice
• electronic prescriptions
• data linkage

Acknowledgements

We wish to thank Dagny Ros Nicolaisdottir for excellent help with data management.

Disclosure statement

All authors declare no competing interest or potential conflicts of interest.

Notes on contributors

Rune Aabenhus is a PhD student and a general practitioner. Rune?s main research areas are within the field of infectious diseases, in particular respiratory tract infections, point-of-care diagnostics and antibiotic treatment.

Malene Plejdrup Hansen is a medical doctor and a senior research fellow. Malene’s research interests include optimising GP’s management of patients with acute respiratory tract infections and the evidence for benefits and harms of using antibiotics.

Volkert Siersma is a mathematician and statistician. Volkert has extensive experience in quantitative research projects relevant to a primary care setting. Volkert har a particular interest in epidemiological modeling of individual data collected at various time points.

Lars Bjerrum is a professor at the University of Copenhagen. He is also a general practitioner and specialist in clinical pharmacy. Lars? research interests include diagnostics and treatment of infectious diseases as well as the development of clinical indicators for prudent antibiotic use in general practice.

Additional information

Funding

RA is funded by a grant from Danish Council on Antibiotic use and Helsefonden (13-B-0196).