<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjph-2018-0023_s_007_w2aab3b7b2b1b6b1aab1c18b1Aa"><h3>Aim</h3><p>The aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014, to describe utilisation trends, and general consequences of antibiotic consumption on antimicrobial resistance.</p></sec><sec id="j_sjph-2018-0023_s_008_w2aab3b7b2b1b6b1aab1c18b2Aa"><h3>Methods</h3><p>Antibiotic utilisation data were obtained from annual reports of both the Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID). Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Descriptive statistics were used to process data and calculate trends.</p></sec><sec id="j_sjph-2018-0023_s_009_w2aab3b7b2b1b6b1aab1c18b3Aa"><h3>Results</h3><p>Overall, utilisation of antibacterials decreased by 4.8% (from 3,35 to 3,19 DDD TID), while trends of individual agents varied substantially – from 87% decline for ceftibuten to 160% rise for levofloxacin. The consumption of quinolones increased by 32.3%. This was mostly due to increased ciprofloxacin consumption (144% raise). Sulfamethoxazole-trimethoprim declined by 57%, while nitrofurantoin increased by 86%. The use of fosfomycin was marginal. Antimicrobial resistance of E. coli increased against quinolones by 54.5%, and against nitrofurantoin by 2–3%. Quinolone resistance of other pathogens (Klebiella spp, Proteus mirabilis), increased variably – between 17.2% (Klebsiella) and 90% (Proteus), while for P. aeruginosa remained the same at 22%.</p></sec><sec id="j_sjph-2018-0023_s_010_w2aab3b7b2b1b6b1aab1c18b4Aa"><h3>Conclusion</h3><p>High rates of antimicrobial utilisation require prescribing restrictions and educational interventions. The increased use of fluoroquinolones is a potentially serious public health threat due to the rapid development of resistance among uropathogens. This threat can be avoided by greater use of nitrofurantoin and fosfomycin.</p></sec></abstract>

AimThe aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014, to describe utilisation trends, and general consequences of antibiotic consumption on antimicrobial resistance.MethodsAntibiotic utilisation data were obtained from annual reports of both the Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID). Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Descriptive statistics were used to process data and calculate trends.ResultsOverall, utilisation of antibacterials decreased by 4.8% (from 3,35 to 3,19 DDD TID), while trends of individual agents varied substantially – from 87% decline for ceftibuten to 160% rise for levofloxacin. The consumption of quinolones increased by 32.3%. This was mostly due to increased ciprofloxacin consumption (144% raise). Sulfamethoxazole-trimethoprim declined by 57%, while nitrofurantoin increased by 86%. The use of fosfomycin was marginal. Antimicrobial resistance of E. coli increased against quinolones by 54.5%, and against nitrofurantoin by 2–3%. Quinolone resistance of other pathogens (Klebiella spp, Proteus mirabilis), increased variably – between 17.2% (Klebsiella) and 90% (Proteus), while for P. aeruginosa remained the same at 22%.ConclusionHigh rates of antimicrobial utilisation require prescribing restrictions and educational interventions. The increased use of fluoroquinolones is a potentially serious public health threat due to the rapid development of resistance among uropathogens. This threat can be avoided by greater use of nitrofurantoin and fosfomycin.

Outpatient antibiotic consumption for urinary infections in Croatia 2005 - 2014: What can be learned from utilization trends

Slovenian Journal of Public Health

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Poraba ambulantno predpisanih antibiotikov pri okužbah sečil na Hrvaškem med leti 2005 in 2014: Kaj se lahko naučimo iz trendov porabe

AimThe aim of this study was to determine quantities of antibiotics used mainly or exclusively for urinary tract infections in Croatia between 2005 and 2014,...

		2007	2008	2009	2010	2011	2012	2013	2014
	hospital	community
E coli
co-amoxiclav	15	19	4	5	5	6	7	7	16
cefuroxime			4	5	6	7	8	8	8
cotrimoxazole			24	24	24	24	24	24	26
norfloxacin	12	14	11	12	13	13	14	14	17
ciprofloxacin	12	14	11	11	13	13	14	14	17
nitrofurantoin			2	3	4	3	3	3	3
Klebsiella p
co-amoxiclav			18	21	21	28	26	25	35
cefuroxime				35	37	40	39	37	39
cotrimoxazole			36	40	37	40	41	36	37
norfloxacin			29	32	31	34	35	32	34
ciprofloxacin			29	32	30	33	34	31	34
nitrofurantoin			35	37	36
Proteus m
co-amoxiclav			13	13	16	16	19	18	18
cefuroxime				14	17	17	20	20	19
cotrimoxazole			35	35	38	36	38	38	36
norfloxacin			12	14	16	17	21	21	21
ciprofloxacin			11	13	16	17	20	20	21
nitrofurantoin			97	98	97	100	100	100	100
Pseudomonas
gentamicin			29	28	28	27	28	26	23
norfloxacin			24	25	23
ciprofloxacin			24	24	22	24	24	23	22
E faecalis
nitrofurantoin			1	1	1	1	1	1	0
norfloxacin									21
E faecium
nitrofurantoin			34	40	23
norfloxacin									80

	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	% of change
QUINOLONES
ciprofloxacin	0.25	0.41	0.45	0.47	0.58	0.59	0.59	0.55	0.59	0.61	144
pefloxacin	0.01	0.01	0	0	0	0	0	0	0	0
norfloxacin	0.95	1.25	0.8	0.81	0.77	0.8	0.7	0.77	0.83	0.86	-9.37
levofloxacin	0	0	0	0	0	0	0	0.05	0.13	0.13
moxifloxacin	0.07	1.1	0.08	0.12	0.12	0.12	0.11	0.1	0.09	0.08
tot quinol	1.27	1.76	1.34	1.41	1.47	1.52	1.39	1.47	1.63	1.68	32.28
CO- TRIMOXAZOLE
Outpatient DDD	1.57	1.35	1.4	1.17	0.98	0.87	0.73	0.72	0.67	0.66
Hospital DDD	0.08	0.07	0.07	0.06	0.06	0.05	0.05	0.06	0.04	0.05
Total DDD	1.65	1.42	1.47	1.23	1.04	0.92	0.78	0.78	0.71	0.71	-57
HRK	4.32	5.3	3.9	9.89	3.53	3.23	2.68	2.46	2.55	2.45
NITROFURANTOIN
nitrofurantoin	0.43	0.65	0.37	0.6	0.69	0.66	0.68	0.7	0.75	0.8	86.05

Outpatient antibiotic consumption for urinary infections in Croatia 2005 - 2014: What can be learned from utilization trends

Article Category: Original scientific article

Published Online: Oct 01, 2018

Page range: 183 - 191

Received: Sep 17, 2017

Accepted: Jun 13, 2018

DOI: https://doi.org/10.2478/sjph-2018-0023

Keywords
antibiotics, utilisation trends, urinary tract infections, bacterial resistance

© 2018 National Institute of Public Health, Slovenia, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Figure 4

Resistance of main uropathogens in Croatia, 2007 – 2014 (in %).

Utilisation of quinolones, co-trimoxazole and nitrofurantoin in Croatia, 2005 – 2014, according to HALMED (DDD TID).

Outpatient antibiotic consumption for urinary infections in Croatia 2005 - 2014: What can be learned from utilization trends

Article Category: Original scientific article

Published Online: Oct 01, 2018

Page range: 183 - 191

Received: Sep 17, 2017

Accepted: Jun 13, 2018

DOI: https://doi.org/10.2478/sjph-2018-0023

Keywordsantibiotics, utilisation trends, urinary tract infections, bacterial resistance

© 2018 National Institute of Public Health, Slovenia, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Figure 4

Resistance of main uropathogens in Croatia, 2007 – 2014 (in %).

Utilisation of quinolones, co-trimoxazole and nitrofurantoin in Croatia, 2005 – 2014, according to HALMED (DDD TID).

Keywords
antibiotics, utilisation trends, urinary tract infections, bacterial resistance