The prescription of antimicrobials by general practitioners: the differences between north and south Italian provinces

ABSTRACT

Background: Antimicrobials resistance (AMR) is an increasingly serious global health problem, both in terms of clinical implications and economic expenditure. In Italy, there are differences in prescribing rates between regions. We aimed to compare these differences in two Italian provinces: one of Emilia Romagna (north region) and one of Puglia (south region).

Methods: The number of antibiotics prescribed packages and the relative expenditure data (year 2015) were obtained. We applied the prescription quality indicators proposed by the European Surveillance of Antimicrobial Consumption for an in-depth analysis.

Results: Both consumption and expenditure were higher in the south province. In the Apulian province also the use of parenteral antibiotics was more frequent. The most prescribed antibiotics in both the provinces were: penicillins (combined or not), macrolides, and fluoroquinolones.

Conclusion: We observed variability between the north and south province in terms of antibiotics prescription. Overall, our study indicates that antibacterials could be overprescribed. The choice of the right antibiotic continues to be a demanding task for practitioners and much still needs to be done in the fight against AMR, starting from a more appropriate use and interventions aimed at raising awareness of antibiotic resistance.

KEYWORDS:

• Antibiotics
• antimicrobial resistance
• antimicrobial stewardship
• prescriptions
• utilization

Article highlights

• Antimicrobial resistance is an increasingly serious global health problem.

• The abuse and misuse of antibiotics are the major causes of resistance.

• The consumption and the expenditure of antibiotics are different worldwide.

• Interventions aimed at raising awareness about antibiotic resistance are needed.

• Much still needs to be done in the fight against antimicrobial resistance.

Acknowledgments

We would like to thank Francesca Puccio, PharmD, who participated in this research when preparing her graduation thesis at the Unit of Pharmacology, University of Bologna. We would also like to thank Dr Francesca Vittoria Rizzi and Dr Annamaria Pia Terlizzi, both hospital pharmacists at the Azienda Unità Sanitaria Locale BAT, Trani, Italy, for their help in data evaluations.

Authors contributions

Substantial contributions to conception or design of the work (A.V, S.B, D.M, G.B), or the acquisition (S.B., D.A, C.P., N.N), analysis (G.B, A.V, D.M., S.B.) or interpretation of data for the work (A.V., S.B., D.M., G.B., D.A, C.P., N.N.). Drafting of the work (G.B, D.M, S.B., A.V.) or revising it critically for important intellectual content (D.A., C.P., N.N.). All authors approved the submitted final version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethical approval

The manuscript does not contain clinical studies or patient data. For this type of study, formal consent is not required.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.