Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators

Figures & data

Table 1. List of proposed disease-specific APQIs in Europe.

No.	Title	Acceptable range (%)
1a.	The percentage of patients aged between 18 and 75 years with acute bronchitis/bronchiolitis (ICPC-2-R: R78) prescribed antibacterials for systemic use (ATC: J01)	0–30
1b.	= 1a. receiving the recommended antibacterials (ATC: J01CA or J01AA)	80–100
1c.	= 1a. receiving quinolones (ATC: J01M)	0–5
2a.	The percentage of patients older than 1 year with acute upper respiratory infection (ICPC-2-R: R74)prescribed antibacterials for systemic use (ATC: J01)	0–20
2b.	= 2a. receiving the recommended antibacterials (ATC: J01CE)	80–100
2c.	= 2a. receiving quinolones (ATC: J01M)	0–5
3a.	The percentage of female patients older than 18 years with cystitis/other urinary infection (ICPC-2-R: U71) prescribed antibacterials for systemic use (ATC: J01)	80–100
3b.	= 3a. receiving the recommended antibacterials (ATC: J01XE or J01EA or J01XX)	80–100
3c.	= 3a. receiving quinolones (ATC: J01M)	0–5
4a.	The percentage of patients older than 1 year with acute tonsillitis (ICPC-2-R: R76) prescribed antibacterials for systemic use (ATC: J01)	0–20
4b.	= 4a. receiving the recommended antibacterials (ATC: J01CE)	80–100
4c.	= 4a. receiving quinolones (ATC: J01M)	0–5
5a.	The percentage of patients older than 18 years with acute/chronic sinusitis (ICPC-2-R: R75) prescribedantibacterials for systemic use (ATC: J01)	0–20
5b.	= 5a. receiving the recommended antibacterials (ATC: J01CA or J01CE)	80–100
5c.	= 5a. receiving quinolones (ATC: J01M)	0–5
6a.	The percentage of patients older than 2 years with acute otitis media/myringitis (ICPC-2-R: H71) prescribed antibacterials for systemic use (ATC: J01)	0–20
6b.	= 6a. receiving the recommended antibacterials (ATC: J01CA or J01CE)	80–100
6c.	= 6a. receiving quinolones (ATC: J01M)	0–5
7a.	The percentage of patients aged between 18 and 65 years with pneumonia (ICPC-2-R: R81) prescribedantibacterials for systemic use (ATC: J01)	90–100
7b.	= 7a. receiving the recommended antibacterials (ATC: J01CA or J01AA)	80–100
7c.	= 7a. receiving quinolones (ATC: J01M)	0–5

J01: antibacterials for systemic use; J01AA: tetracyclines; J01CA: penicillins with extended spectrum; J01CE: β-Lactamase sensitive penicillins; J01EA: trimethoprim and derivatives; J01M: quinolone antibacterials; J01XE: nitrofuran derivatives; J01XX: other antibacterials.

Table 2. Country specific data and characteristic of dataset.

Country	Belgium	Netherlands	Sweden
Population in whole country (2012) (source: www.statista.com)	11.1 million	16.7 million	9.6 million
DID^a (year 2012)	29.8	11.3	14.1
PID^b (year 2009)	2.53	1.53	1.19
No. of practices in study	46	45	52
No. of GPs in study	94	160	212
Total no. of patients registered with the practices	113 549^c	266 417	338 149
No. of consultations (diagnosis in study with gender and age limitations)	34 044	55 529	59 534
Total no. of consultations per 1000 PY^d, (diagnoses in study with gender and age limitations)	341	329	243
Total no. of prescriptions per 1000 PY^d (diagnoses in study with gender and age limitations)	189	170	138

^a Defined daily dose (DDD) per 1000 inhabitants per day, Reference [6].

^b No. of packages per 1000 inhabitants per day, Reference [6].

^c Estimated according to Reference [15].

^d PY refers to the number of registered patients in the participating practices per year.

Table 3. Values for APQIs according to age and gender limits.

Diagnostic code^a	R74			R75			R76			H71			R78			R81			U71
Diagnoses in text	Upper respiratory infection acute			Sinusitis acute/chronic			Tonsillitis acute			Acute otitis media			Acute bronchitis/bronchiolitis			Pneumonia			Cystitis/urinary infection other
Population (age group)	>1 years			>18 years			>1 years			>2 years			18–75 years			18–65 years			Female >18 years
Country	BE	NL	SE	BE	NL	SE	BE	NL	SE	BE	NL	SE	BE	NL	SE	BE	NL	SE	BE	NL	SE
Consultation incidence^b	190	75	66	22	35	16	20	14	28	18	22	14	43	17	22	3	10	16	45	156	81
Percentage prescribed antibiotic/Indicator a	38	19	8	67	48	69	78	57	86	62	45	75	80	54	33	69	67	77	87	67	84
Acceptable range (%)	0–20			0–20			0–20			0–20			0–30			90–100			80–100
Percentage recommended antibiotic/Indicator b	1	7	57	37	22	77	14	72	87	61	81	91	39	83	71	30	74	47	62	83	41
Acceptable range (%)	80–100			80–100			80–100			80–100			80–100			80–100			80–100
b (percentage according to national guidelines)^c	1	77	92	34	81	70	9	72	87	61	81	84	34	83	70	–	73	42	22	73	87
Percentage quinolones/Indicator c	5	0.6	1	11	0.4	0	0	0.1	0	2	0.2	0	15	0.4	2	19	1.6	1	22	7.4	3
Acceptable range (%)	0–5			0–5			0–5			0–5			0–5			0–5			0–5
Antibiotic prescription per 1000 PY^d	72	14	5	15	17	11	16	8	24	11	10	11	34	9	7	2	7	12	39	105	68

^a See Supplement 1 for ICPC-2-R and ICD-10 codes included in study.

^bNo. of consultations per 1000 registered patients.

^cPercentage treated with first-choice antibiotic according to national guidelines (value not available for pneumonia in BE due to patients being sent to hospital for treatment).

^dPY = No. of patient registered per year.

Values in italic and bold are outside the proposed acceptable range (see Table 1).

Adriaenssens N, Coenen S, Versporten A, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997-2009). J Antimicrob Chemother. 2011;66(Suppl.6):vi3–v12.

 PubMed Web of Science ®Google Scholar

Bartholomeeusen S, Kim C-Y, Mertens R, et al. The denominator in general practice, a new approach from the Intego database. Fam Pract. 2005;22:442–447.

 PubMed Web of Science ®Google Scholar