Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation

Abstract

Purpose

The purpose was to analyze drug prescription and antibiotic use by age and sex in Italy’s Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level.

Methods

This was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient’s municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test.

Results

There were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults.

Conclusion

A considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.

Keywords:

• antibiotic use
• drug utilization
• prescription patterns
• real-world data

Acknowledgment

This study is part of a set of initiatives to promote the appropriate drug use and drug safety in Campania Region.

Ethical Considerations

All procedures performed in this study were in accordance with the current national law from the Italian Medicines Agency. The article does not contain clinical studies, and all patients’ data were fully anonymized. For this type of study, formal consent was not required. Permission to use anonymized data for the present study was granted by the responsible authority, “Unità del Farmaco, Regione Campania”.

Author Contributions

All authors contributed towards data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. 

Disclosure

No funding was provided for this work and the authors report no conflicts of interest in this work.