Antibiotic prescriptions in primary health care in a rural population in Crete, Greece

BMC Research Notes, Dec 2011

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.

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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)


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Nikolaos Kontarakis, Ioanna G Tsiligianni, Polyvios Papadokostakis, Evangelia Giannopoulou, Loukas Tsironis, Vasilios Moustakis. Antibiotic prescriptions in primary health care in a rural population in Crete, Greece, BMC Research Notes, 2011, pp. 38, Volume 4, Issue 1, DOI: 10.1186/1756-0500-4-38