Antimicrobial use in humans Ann Versporten Prof. Herman Goossens OIE Global Conference on the Responsible and Prudent Use of Antimicrobial Agents for Animals - 13 March 2013 - Ann.versporten@ua.ac.be Herman.goossens@uza.be
If you cannot measure it, you cannot improve it Lord Kelvin 1824-1907
Importent research questions What is the quantity and quality of antibiotic use Geographical distribution and ranges Outpatient inpatient use Adults children. What are the determinants of inappropriate antibiotic use? Patient related (diagnosis, age, underlying disease,.) Prescriber related (training) Institutional factors (national/local policy, availability of drugs on market, existing guidelines, hospital type,.) Cultural factors, custums,. 3
Collection of antibiotic use data We need: Valid, representative and comparable data Interpretable units of measurement to express volumes of antibiotic use Longitudinal data to analyze trends over time Evaluation methods to assess impact of interventions aiming at optimizing antibiotic use Common methodology 4
How measuring human antibiotic use WHO ATC/DDD classification method = gold standard measuring unit for international human drug utilization research: o Anatomical Therapeutic Chemical (ATC) classification system (5 levels up to substance level) o Defined Daily Doses (DDD) = assumed average maintenance dose per day for a drug used for its main indication in adults. Drug specifications needed: unit strength & pack size http://www.whocc.no/
How measuring human antibiotic use N prescriptions N persons Nominators N prescribed daily doses N packages.. N days of therapy N Defined Daily Doses All prescriptions All persons insured Denominators All inpatients All persons All prescribed daily doses All days of therapy All admissions All full courses Total population
Interpretation of antibiotic use data Critical factors: o Dosage (strength of active ingredient) o Duration of therapy and time interval o Clinical justification o Targeted / empirical treatment o Choice of drug (availability on market) o Indication (community acquired hospital acquired infection) o Guidelines o Local resistance patterns o
Total outpatient antibiotic use in 33 European countries in 2009 in DID (2004 data for Switzerland). Adriaenssens N et al. J. Antimicrob. Chemother. 2011;66:vi3-vi12 The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
Outpatient use of penicillins in 33 European countries in 2009 in DID (2004 data for Switzerland). Versporten A et al. J. Antimicrob. Chemother. 2011;66:vi13-vi23 The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com
Assessing impact of interventions Antibiotic consumption DDD packages Campaigns persons DID Perso nsid PID PrID Prescriptions T i m e Antibiotic resistance
Belgian National Public Campaigns When: since November 2000, annually during winter season Organised by BAPCOC (Belgian Antibiotic Policy Coordination Committee) Budget: 400,000 /annual campaign Interventions targeting the public & professionals: o TV, radio and newspaper o Information booklets o Folders o Posters o Internet campaigns: www.antibiotics-info.be
Packages per 1000 inhabitants per day Outpatient antibiotic use in Belgium 1997-2010 in Packages per 1000 Inhabitants per Day 4-1.0% -3.4% -37% 3.5-6.4% Other J01 classes 3-9.1% -6.9% Sulfonamides and trimethoprim (J01E) 2.5-7.5% -4.0% -3.5% -7.3% +0,8% -0.3% -0.8% Quinolones (J01M) 2 Macrolides, lincosamides and streptogramins (J01F) 1.5 Tetracyclines (J01A) 1 Cephalosporins and other betalactams (J01D) Penicillins (J01C) 0.5 0 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10
DDD per 1000 inhabitants per day Outpatient antibiotic use in Belgium 1997-2010 in DDD per 1000 Inhabitants per Day 30-0.1% 25 +2.6% -1.8% -3.9% -5.5% +2.1% +1.5% -0.6% -1.3% -0.9% +5.3% +2.7% -0.6% Other J01 classes Sulfonamides and trimethoprim (J01E) 20 Quinolones (J01M) 15 Macrolides, lincosamides and streptogramins (J01F) Tetracyclines (J01A) 10 Cephalosporins and other betalactams (J01D) 5 Penicillins (J01C) 0 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10
Key message : obtain meaningful comparisons Uniformity of data collection - Use similar study designs, standardized protocol and data collection templates SIMPLE protocol = feasible & achievable surveillance Quality assurance approach implementation of data validation process Continuous work on data accuracy Central support towards data collection or other (helpdesk) Mutual cooperation/feedback is highly motivating sustained awareness 15
Conclusion Implementation of a common methodology to collect valid, representative and comparable antimicrobial consumption data Employ different outcome measurement units enabling an in-depth interpretation of antimicrobial consumption data Creation of reference database at national and international level Potential of scientific output Potential to link with antimicrobial resistance data Potential to link with other research projects Networking Sustainability 16
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