AKADEMIJA MEDICINSKIH ZNANOSTI HRVATSKE KOLEGIJ JAVNOG ZDRAVSTVA ODBOR ZA PRAĆENJE REZISTENCIJE BAKTERIJA NA ANTIBIOTIKE U REPUBLICI HRVATSKOJ CROATIAN ACADEMY OF MEDICAL SCIENCES PUBLIC HEALTH COLLEGIUM COMMITTEE FOR ANTIBIOTIC RESISTANCE SURVEILLANCE IN CROATIA Potrošnja antibiotika u Hrvatskoj Antibiotic consumption in Croatia European Surveillance of Antibiotic Consumption (ESAC) Izvješće pripremili: Report prepared by: Doc.dr. Arjana Tambić Andrašević Klinika za infektivne bolesti «Dr. Fran Mihaljević», Zagreb Dr. Marina Payerl Pal Zavod za javno zdravstvo Međimurske županije, Čakovec Predstavnici Hrvatske u ESAC projektu ESAC Representatives for Croatia Doc.dr. Arjana Tambić Andrašević Prof.dr. Igor Francetić 99
Potrošnja antibiotika u Hrvatskoj Potrošnja antibiotika je jedan od osnovnih pokretača razvoja rezistencije bakterija na antibiotike te je uz praćenje rezistencije na antibiotike nužno pratiti i njihovu potrošnju. Rezultati o potrošnji antibiotika u ovom izvješću se zasnivaju na podacima veleprodaje u cijeloj Hrvatskoj i odvojeno je prikazana bolnička i izvanbolnička potrošnja. Podaci su dio izvješća za ESAC te su i rezultati izraženi prema ESAC preporukama tj. kao broj definiranih dnevnih doza (DDD) na tisuću stanovnika dnevno kako za izvanbolničku tako i za bolničku potrošnju. DDD su određene prema normama Svjetske zdravstvene organizacije (WHO ATC/DDD klasifikacija). Iz godine u godinu uočen je porast potrošnje antibiotika, kako u bolnici tako i u izvanbolničkoj praksi. Gotovo 90% antibiotika se potroši u izvanbolničkom liječenju. Do većeg skoka u izvanbolničkoj potrošnji antibiotika je došlo između 2001.g. (18.65) i 2002.g. Do porasta je došlo u potrošnji tetraciklina, usko i široko lnih penicilina te naročito amoksicilina s inhibitorom beta-laktamaza. Povećana potrošnja amoksicilina s inhibitorom beta-laktamaza nije rezultat povećanog broja prepisanih terapijskih doza (broj prodanih paketića je gotovo isti u obje godine), već je odraz uvođenja novog preparata s povećanim udjelom amoksicilina u dnevnoj dozi. Kako su administrativne DDD ostale iste broj potrošenih DDD je naglo porastao uz približno isti broj prodanih terapijskih doza (slika 1). Potrošnja antibiotika u bolnici je prikazana u vrlo grubim podacima (izražena na 1000 stanovnika dnevno) u skladu s ESAC smjernicama. Cilj je Odbora uspostaviti detaljnije praćenje bolničke potrošnje antibiotika u pojedinim centrima s brojem bolničkih dana / primitaka u nazivniku. Antibiotic consumption in Croatia Antibiotic consumption is a driving force for the development and spread of antibiotic resistance. Therefore it is necessary to monitor antibiotic consumption along with the antibiotic resistance surveillance. In this report antibiotic consumption results are based on the wholesales data for the whole Croatia. Hospital and ambulatory consumption are reported separately. These results are a part of the ESAC report so they are expressed in concordance with the ESAC requirements i.e. as defined daily doses (DDD) per thousand inhabitants per day. DDD are determined by the World health organization (WHO ATC/DDD classification). Both ambulatory and hospital antibiotic consumption is increasing from year to year. Almost 90% of antibiotics are prescribed for ambulatory treatment. There was a significant increase in ambulatory antibiotic consumption in 2002. This was largely due to the increase in tetracycline, broad and narrow spectrum penicillins and particularly amoxicillin with betalactamase inhibitor. Increased amoxicillin with beta-lactamase inhibitor consumption is not a result of increased prescribing of this antibiotic (the number of packages sold is almost identical in 2001 and 2002) but could be explained by the introduction of the new bid formula with the increased amoxicillin content in a daily dose. As the administrative DDD remained 100
the same the number of DDD increased although the number of therapeutic daily doses actually remained the same (figure 1). Hospital antibiotic consumption is presented with very rough data, expressed in DDD per thousand inhabitants daily according to the ESAC guidelines. It is the aim of the Committee to introduce more detailed consumption surveillance in different centers with hospital bed days and admissions as denominators. Slika 1. Figure 1 Izvanbolnička potrošnja antibiotika Ambulatory antibiotic consumption 25 Ambulant consumption DDD / TID Introduction of co-amoxiclav BID 20 15 10 5 0 2000 2001 2002 tetracyclines quinolones MLS sulfonamides cephalosporins pen+inhibitor BS penicillins NS penicillins 101
Tablica 1. Table 1 Izvanbolnička potrošnja antibiotika (DDD/TID) Ambulatory antibiotic consumption (DDD/TID) ATC šifra ATC code JO1AA JO1CA JO1CE ANTIBIOTIK ANTIBIOTIC Tetracylines 2001 2002 2003 1.39 1.82 1.90 Penicilini širokog Broad spectrum penicillins 4.09 4.95 4.87 Penicilini uskog Narrow spectrum penicillins 1.18 1.78 1.85 JO1CF Beta-laktamaza rezistentni penicilini Beta-lactamase resistant penicillins 0.06 0.06 0.12 JO1CR Kombinacije s betalaktamaza inhibitorima 3.77 5.21 5.24 JO1DA Cefalosporini I gen. I gen. cephalosporins 1.65 1.99 1.94 Cefalosporini II gen. II gen. cephalosporins 1.14 1.34 0.39 Cefalosporini III gen. III gen. cephalosporins 0.38 0.35 0.44 JO1EE Sulfonamides + trimethoprim 1.70 1.85 1.72 JO1F Macrolides, lincosamides 1.88 1.92 2.07 JO1G Aminoglycosides 0.06 0.04 0.01 JO1MA Fluoroquinolones 1.34 1.52 1.53 TOTAL 18.65 22.86 22.18 102
Tablica 2. Table 2 Bolnička potrošnja antibiotika (DDD/TID) Hospital antibiotic consumption (DDD/TID) ATC šifra ATC code JO1AA JO1CA JO1CE ANTIBIOTIK ANTIBIOTIC Tetracylines 2001 2002 2003 0.07 0.12 0.15 Penicilini širokog Broad spectrum penicillins 0.27 0.30 0.33 Penicilini uskog Narrow spectrum penicillins 0.08 0.24 0.35 JO1CF Beta-laktamaza rezistentni penicilini Beta-lactamase resistant penicillins 0.03 0.04 0.04 JO1CR Kombinacije s betalaktamaza inhibitorima 0.52 0.64 0.79 JO1DA Cefalosporini I gen. I gen. cephalosporins 0.14 0.20 0.17 Cefalosporini II gen. II gen. cephalosporins 0.26 0.28 0.19 Cefalosporini III gen. III gen. cephalosporins 0.09 0.09 0.12 JO1DH Carbapenems 0.01 0.02 0.02 JO1EE Sulfonamides + trimethoprim 0.09 0.14 0.20 JO1F Macrolides, lincosamides 0.13 0.14 0.16 JO1G Aminoglycosides 0.11 0.15 0.12 JO1MA Fluoroquinolones 0.16 0.18 0.22 JO1XA Glycopeptides 0.02 0.02 0.02 JO1XD Metronidazole 0.03 0.06 0.06 TOTAL 2.04 2.52 2.94 103