Antibiotic prescriptions in primary health care in a rural population in Crete, Greece
BMC Research Notes
Antibiotic prescriptions in primary health care in a rural population in Crete, Greece
Nikolaos Kontarakis 0
Ioanna G Tsiligianni 0
Polyvios Papadokostakis 2
Evangelia Giannopoulou 1
Loukas Tsironis 3
Vasilios Moustakis 3
0 Agia Barbara Health Care Center , Heraklion, Crete, P.O 70003 , Greece
1 University hospital of Heraklion , Heraklion, Crete, P.O 71201 , Greece
2 Archalohori Primary Health Care Center , Heraklion, Crete, P.O 70300 , Greece
3 Technical University of Crete , Chania, Crete, P.O 73100 , Greece
Background: Antibiotic over-prescribing has generally been considered to be common in Greece, however not much is known about current antibiotic use. Findings: The aim of this study was to investigate antibiotic prescribing in a well-defined rural population of 159 adults and 99 children over a 12-month period in Crete, Greece. The daily-defined doses (DDD) for 1000 people/ day (DID) were 22.1 and 24.2 for children and adults respectively. The overall DID was 23.4, markedly lower than that previously reported for Greece. The use of penicillins was 49.5% of DDD in children and 31.7% in adults. Quinolones represented 2.2% of the total antibiotics (0% in children). Prescriptions of antibiotics were more common during the 3-month period from January to March for both children and adults. Conclusions: The findings of this study confirm the seasonal distribution of antibiotics used and the predominance of prescribing for respiratory tract infections. In the area of the study, antibiotic use seems to be lower than that previously reported for Greece, probably as a result of the recently established net of well-trained primary health physicians.
Background
Antibiotic prescribing in primary care rose steadily
during the last decade world-wide, in many European
countries [
1-7
]. Unnecessary antibiotic prescribing remains
the cardinal contributing factor to the development of
antibiotic resistance [
4,5,7,8
]. Primary health care
practitioners have been shown to account for the majority of
antibiotic prescribing [3]. To prevent overprescribing,
detailed data on antibiotic utilization should be obtained
[
9-11
]. The use of markers such as the daily defined
doses of antibiotics (DDD), and the daily defined doses
for 1000 people/day (DID) for the estimation of
antibiotic use has facilitated the comparison of the findings in
various countries [
12
]. Greece is among the European
countries with the highest antibiotic prescribing and
resistance to bacteria [
3,4
]. Information is very limited
for Crete, the major island of Greece [
3,13-17
]. The aim
of this study was to investigate antibiotic use in primary
health care in a region of Crete for a period of
12 months as well as to highlight the important role of
the family physicians.
Methods
The rural municipality of Gorgolaini, prefecture of
Heraklion, Crete, has a population of 3026 (1543 male, 1483
female). Primary health services consist of two public
medical offices with 3 general practitioners. From an
initial sample of 2394 permanent residents, a
representative cohort of 330 individuals was formed by the method
used for systematic samples of municipalities [
18,19
]. Of
them, 30 (9%) denied participation, and 42 (12.7%) were
not included due to lack of proper information on
medical history and drug prescription. In total, 258 persons
participated in the study.
The collection of data for the 12-month period from
January 1 through December 31 was performed in
February and March of the following year (2005).
Individual health and prescription booklets were reviewed for
medical visits and prescriptions, and demographic and
insurance data were recorded. For each medical visit for
an infection, the prescribed medication and dosage of
the prescribed medication packages were recorded.
Drugs were coded according to the Anatomical
Therapeutic Chemical (ATC) classification system and the
doses according to the Defined Daily Dose (DDD)
system [
12
]. The diseases were coded according to the
World Health Organization-International Classification
of Diseases System (WHO-ICD 10). The statistical
analysis was performed using the SPSS v.17.0. Chi-square
test was used in order to compare study variables.
Statistical significance was accepted at the 5% level.
Ethics
The scientific committee of the Venizeleion Hospital of
Heraklion, Crete approved this study. All patients were
willing to participate in the study, and were informed
about the scope and the purpose of the study and gave
their consent.
Results
The age distribution of the population of the study was
as follows: male, age group 0-18: 21.7%, age group
19-65: 16.2%, age group 65+: 9.6%; and female age
group 0-18: 16.6%, age group 19-65: 21.3%, age group
65+ 14.6%. No significant difference was found between
males and females regarding age.
The distribution of diagnoses is depicted in Table 1.
Table 2 indicates the most frequently prescribed drugs,
in DDDs and DIDs. The DI (...truncated)