¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar? / Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?

El consumo excesivo de antibióticos genera altas tasas de resistencia. En Aragón, los valores máximos de prescripción de antibióticos se alcanzan en los niños de 1 a 4 años, con una utilización que supera el 60%.ObjetivoEvaluar si una intervención multidisciplinar sobre pediatras de atención primaria reduce la utilización de antibióticos y mejora su perfil de prescripción. Método Se analizaron datos de prescripción de antibióticos antes y después de un proyecto de intervención sobre pediatras de atención primaria. La intervención consistió en un taller formativo sobre diagnóstico y tratamiento de las enfermedades infecciosas más prevalentes en pediatría, habilidades en entrevista clínica y adecuada utilización de test rápido de detección de estreptococo en faringe. Se aportaron guías de práctica clínica y documentos de consenso en patología infecciosa pediátrica y material divulgativo para padres. Se utilizó grupo control con pediatras no participantes. Resultados El consumo de antibióticos bajó de 19,17 dosis diarias definida por 1.000 habitantes/día (DHD) a 14,36 DHD entre los pediatras participantes y de 19,84 DHD a 16,02 DHD en controles, aunque la diferencia no fue significativa. Se produjo una disminución de la utilización de macrólidos y penicilinas de amplio espectro en ambos grupos. Conclusión La prescripción de antibióticos de los pediatras disminuyó, no observándose diferencias estadísticamente significativas entre los grupos de estudio. Dado el alto grado de satisfacción de los pediatras participantes, sería necesario continuar con este tipo de actividades para mejorar la utilización de antibióticos en nuestro ámbito

Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%.AimTo evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. Methods Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. Results Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. Conclusion Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatient

[Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?]. / ¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar?

UNLABELLED: Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%. AIM: To evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. METHODS: Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. RESULTS: Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. CONCLUSION: Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatients.

Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad / Outpatient antibiotic prescription in Aragón and the differences by gender and age

Introducción: El objetivo de este estudio es describir la prescripción de antibióticos en atención extrahospitalaria y su patrón de consumo por subgrupos, analizar los patrones de utilización por edad y sexo e identificar pacientes hiperconsumidores. Métodos Estudio observacional retrospectivo en el que se estimó la proporción de habitantes de Aragón que habían sido tratados con antibióticos en 2008. Los datos se obtuvieron del Sistema de Información de Consumo Farmacéutico de Aragón, que recoge las recetas dispensadas en oficinas de farmacia. Se calcularon la tasa de habitantes expuestos a tratamiento antibiótico y la dosis diaria definida (DDD) por mil habitantes/día (DHD).Resultados La tasa de prescripción de antibióticos en 2008 en Aragón fue de 339,81 por 1.000 habitantes (303,54 por 1.000 en hombres y 375,34 por 1.000 en mujeres). La prescripción extrahospitalaria de antibióticos en Aragón fue de 23,72 DHD. La frecuencia de consumo presenta diferencias importantes en función de la edad y el sexo. En los niños de 0 a 4 años se observa la mayor tasa de utilización de antibióticos, y las mujeres, en general, presentan una mayor frecuencia de consumo que los hombres. Las penicilinas son el subgrupo de antibióticos más utilizado en todos los grupos de edad, excepto en los mayores de 80 años, en quienes son desplazadas por las quinolonas. El mayor porcentaje de pacientes considerados hiperconsumidores en adultos (más de 60 DDD de antibióticos al año) tuvo lugar en el grupo entre 60 y 80 años. Conclusión Se observó una elevada prescripción de antibióticos en Aragón, siendo llamativo el elevado consumo en los niños más pequeños, y las diferencias entre mujeres y hombres (AU)

Background: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. Methods: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. Results: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than60 DDDs/year) were in the 60-80 years age group. Conclusion: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics (AU)

[Outpatient antibiotic prescription in Aragón and the differences by gender and age]. / Prescripción extrahospitalaria de antibióticos en Aragón y sus diferencias por género y edad.

BACKGROUND: The objective of the study is to describe the use of antibiotics among outpatients, the pattern of sub-group prescribing, as well as to analyse age- and gender-specific patterns of use, and to identify high users. METHODS: A retrospective, observational study was designed, in which the rate of patients treated with antibiotics in Aragon (Spain) in 2008 was calculated. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions in Aragon in 2008. Defined Daily Dose (DDD) per 1000 inhabitants per day (DID) was calculated, and the number of patients who had received an antibacterial drug was analysed. RESULTS: The antibiotic prescription rate in 2008 in Aragón was 339.81 per 1000 inhabitants (303.54 and 375.34 per 1000 for men and women, respectively). The DID was 23.72. Population prevalence of antimicrobial use changed markedly between different age groups and between genders. Children (0-4 years) had the highest rate. Females, in general, used antibiotics more than males. Penicillins was the most used antibacterial group in all age groups, except for people of advanced age (>80 years), where quinolones were the most frequently used. Most of the individuals defined as high users (using more than 60 DDDs/year) were in the 60-80 years age group. CONCLUSION: We observed a high antibiotic prescription rate in Aragon, particularly in children. There are differences between men and women in the use of antibiotics.

[Variations in the prescription of antibiotics among primary care areas in the autonomous region of Aragon, Spain]. / Variabilidad de la prescripción de antibióticos en atención primaria de los sectores sanitarios de Aragón.

BACKGROUND: Resistance to antibacterial drugs can be contained by judicious utilization, so we must know about its use. The objective is to describe the prevalence of antibiotic consumption and the variability in the use of antibiotics among outpatients in the different health areas of Aragon. METHODS: Study of the prescription of antibiotics in the health areas of Aragon in 2008. Data were extracted from the Aragon Pharmaceutical Consumption Database, a complete register of all dispensed prescriptions. Prescription rates per 1000 individuals adjusted by sex and age were calculated using a direct and indirect standardization method. The subgroups utilization were calculated in Defined Daily Dose per 1000 inhabitants per day (DID). In the variation analysis were used: extremal quotient (EQ), coefficient of variation (CV), weighted coefficient of variation (CVw). RESULTS: The adjusted rate of antibiotic varied between 279,8 and 382 per 1000 inhabitants, showing a CVw=0,12. The utilization rate in women was 364.9 per 1,000 and in men 300.0 per 1,000. Cephalosporins have a EQ=2,42 and CVw=0,37; and quinolones have EQ=1,84 and CVw=0,22. CONCLUSIONS: The utilization rate was higher in women than men. The higher variability in the prescription of antibiotics among health areas in Aragon was in cephalosporins and quinolones.

Variabilidad en la utilización de nuevos medicamentos en un área de Atención Primaria / Variability in the Use of New Drugs in a Primary Care District

Fundamento: La utilización de nuevos fármacos ha aumentadode forma importante en los últimos años. El objetivo de este trabajoes conocer la utilización de novedades farmacéuticas en un área desalud de Zaragoza, describir cuales son las más utilizadas y su evoluciónen el tiempo y analizar las características de los centros que seasocian con un mayor uso de estos medicamentos.Métodos: Se trata de un estudio descriptivo en el que se analizarontodas las dispensaciones de 50 nuevos principios activos comercializadosentre el 1-1-2000 y el 31-12-2003 en un área de salud. Secalculó el porcentaje de utilización de novedades durante el primeraño de su comercialización, en cada centro de atención primaria, y seanalizaron las características de los centros que se asociaban conmayor grado de innovación.Resultados: El 76% de los 50 nuevos fármacos comercializadoseran escasamente innovadores respecto a los ya existentes. Las dieznovedades más prescritas comenzaron a utilizarse en el primer cuatrimestretras su aparición en el mercado. El porcentaje de utilizaciónde novedades respecto al total de fármacos prescritos en los centrosde salud estudiados osciló entre el 0,3% y el 1,18%. En el análisisefectuado por centros, el «gasto por paciente» y las «consultas pormédico» se correlacionaron positivamente con un mayor uso demedicamentos nuevos, mientras que el porcentaje de pensionistaspresentó una relación inversa.Conclusiones: Existe una gran variabilidad en el porcentaje deutilización de novedades farmacológicas entre los centros de atenciónprimaria. Los centros con mayor número de consultas por facultativoson los que tienden a incorporar los nuevos medicamentos conmayor facilidad

Background: The use of new drugs has undergone a majorincrease in recent years. This study is aimed at ascertaining thedegree to which pharmaceutical novelties are being used in onehealthcare district in Zaragoza, describing which are those mostused and the trend thereof over the course of time in addition toanalyzing the characteristics of those centers associated with a greateruse of these drugs.Methods: A descriptive study analyzing all of the dispensationsof fifty new active ingredients marketed within the January 1, 2000 -December 31, 2003 period in one healthcare district. The percentageof use of novelties throughout the first year these drugs were marketedat each primary care center was calculated, the characteristicsof those centers associated with a greater degree of innovationhaving been analyzed.Results: Seventy-six percent of the fifty new drugs marketedwere barely innovative in comparison to the existing ones. The tennew drugs most prescribed began being used during the first fourmonths immediately after coming out on the market. The percentageof use of new drugs as compared to all of the drugs prescribed at thehealthcare centers studied fell within the 0.3% -1.18% range. In theanalysis made by centers, the «per-patient expense» and the «consultationsper physician» are positively correlated with a greater useof new drugs, whilst the percentage of retirees showed a reverseratio.Conclusions: A high degree of variability exists in the percentageof use of pharmaceutical novelties among the primary care centers.The centers having the largest number of consultations perphysician are those tending toward more readily incorporating thesenew drugs