Sakarya İli'nde Antibiyotik Tüketim Sıklığının Araştırılması

Year 2023, Volume: 13 Issue: 3, 456 - 464, 30.09.2023

Hüseyin Pehlivan , Oğuz Karabay , Ayten Yılmaz Yalçıner , Aziz Öğütlü , Elif Elçin Günay

https://doi.org/10.31832/smj.1185249

Abstract

Amaç: Antibiyotik tüketiminin halk sağlığı açısından oldukça kritik olması nedeniyle, 2019 yılı için maliyet ve reçeteyle ilgili faktörler açısından Sakarya ilinde görev yapan Aile Hekimleri (FP) ve aile hekimleri dışındaki doktorlar (ODTP'ler) tarafından reçete edilen antibiyotik kutu sayılarına ait verilerin analiz edilmesi ve değerlendirilmesi amaçlanmıştır.
Yöntemler: Bu çalışma, retrospektif verilere dayanarak antibiyotik tüketiminin ölçülmesine dayanmaktadır. Türkiye ve Sakarya iline ait 2019 yılı için reçete edilen antibiyotik kutu sayıları analiz edilerek maliyet ve hekimlerin uzmanlıklarına göre karşılaştırma yapılmıştır. Analizdeki ki-kare homojenlik testi ve iki örnekli Poisson testi kullanılmıştır. p değerinin 0,05'ten küçük olması anlamlı olarak kabul edilmiştir.
Bulgular: Sakarya'daki FP (z = 307,57, p-değeri < 0,0001) ve ODTFP'ler (z = 278,27, p-değeri < 0,0001) için kişi başına düşen konsültasyon oranı Türkiye'dekilerden anlamlı derecede yüksektir. Ancak Sakarya'daki hem FP (Chi-Sq =17231.434, df = 1, p-değeri <0,0001) hem de ODTFP'lerin (Chi-Sq = 5197.376, df = 1, p-değeri < 0,0001) Türkiye geneline göre daha az sayıda antibiyotik reçete ettiği görülmektedir. 2019 yılında en çok reçete edilen antibiyotik grubu J01C penisilinler ve türevleridir.
Sonuç: Sakarya'da Türkiye geneline göre daha az antibiyotiğin reçete edilmesinin nedeninin, hekimlere verilen düzenli eğitim ve geri bildirim olduğu düşünülmektedir. Bu bağlamda hastanelerde uygulanan geri bildirim politikaları antibiyotik tüketimi yönetimi açısından oldukça değerlidir ve hekimlerin mezuniyet sonrası eğitimleri de akılcı antibiyotik kullanımı açısından oldukça faydalıdır.

Keywords

antibiyotik, tüketim, sürveyans

Investigation of Antibiotic Prescription Related Factors in Sakarya Province

Abstract

Aim: Because consumption of antibiotics is very critical for public health, it was aimed to analyze and evaluate the data of number of antibiotic packages prescribed by Family Physician (FP) and other doctors than family physicians (ODTFPs) serving in the province of Sakarya and Turkey in terms of cost and prescription related factors for 2019.
Methods: This study was based on the measurement of antibiotic consumption relied on retrospective data. The number of antibiotic packages prescribed for the year 2019 belonging to Turkey and Sakarya province was analyzed and compared based on cost and expertise of physicians. Chi-square test of homogeneity and two-sample Poisson tests were used in the analysis. p value less than 0.05 was accepted as significant.
Results: Consultation per capita for FPs (z = 307.57, p-value < 0.0001) and ODTFPs (z = 278.27, p-value < 0.0001) in Sakarya were significantly higher than that of those in Turkey. However, both FPs (Chi-Sq =17231.434, df = 1, p-value <0.0001) and ODTFPs (Chi-Sq = 5197.376, df = 1, p-value < 0.0001) in Sakarya prescribed fewer antibiotics than that of in Turkey for 2019. The most prescribed antibiotic group was the J01C group penicillins and its derivatives.
Conclusions: It is thought that the reasons of fewer antibiotics prescribed in Sakarya than in Turkey are related to regular training and feedback to physicians. In this context, feedback policies implemented in hospitals are very valuable for antibiotic consumption management. And post-graduate training of physicians is very beneficial for rational antibiotic usage.

Keywords

Antibiotic, consumption, surveillance

References

• 1. Avci IY, Kilic S, Acikel CH et al. Prescription of oral antibiotics in a training hospital in Turkey: Trends in the last decade. J Infection. 2006; 52: 9–14.
• 2. Erbay A, Bodur H, Akinci E, Colpan A. Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey. Journal Hosp Infect. 2005; 59(1):53-61.
• 3. Hamidi AA, Yılmaz S. Antibiotic consumption in the hospital during COVID-19 pandemic, distribution of bacterial agents and antimicrobial resistance: A single-center study. Journal Surg Med. 2021;5(2):124-127.
• 4. Borg MA, Zarb P, Ferech M, Goossens H. Antibiotic consumption in southern and eastern Mediterranean hospitals: results from the ARMed Project on behalf of the ARMed Project Group. J Antimicrobial Chemotherapy. 2008; 62: 830–836.
• 5. Versporten A, Bolokhovets G, Ghazaryan L et al. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis. 2014;14(5):381-7.
• 6. Isler B, Keske S, Aksoy M et al. Antibiotic overconsumption and resistance in Turkey. Clinical Microbiology and Infection. 2019; 25: 651-653.
• 7. Cinaroglu S, Baser O. Factors related to outpatient drug consumption in Turkey. Value in Health. 2017; 20 (9) A399-811.
• 8. Klein EY, Milkowska-Shibata M, Tseng KK, et al. Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000-15: an analysis of pharmaceutical sales data. Lancet Infect Dis. 2021; 21(1):107-115.
• 9. Turkdogan FI, Yetilmezsoy K. Appraisal of potential environmental risks associated with human antibiotic consumption in Turkey. J Hazard Mater. 2009;166(1):297-308.
• 10. Kim HL, Rodriguez RD, Morris SK, Zhao S, Donato JJ. Identification of a novel plasmid-borne gentamicin resistance gene in nontyphoidal salmonella isolated from retail Turkey. Antimicrob Agents Chemother. 2020; 64(11):e00867-20.
• 11. Abraham NM, Liu L, Jutras BL et al. A Tick antivirulence protein potentiates antibiotics against staphylococcus aureus. Antimicrob Agents Chemother. 2017; 61(7):e00113-17.
• 12. Howard P, Huttner B, Beovic B et al. Indicators Working Group. ESGAP inventory of target indicators assessing antibiotic prescriptions: a cross-sectional survey. J Antimicrob Chemother. 2017; 72: 2910–2914.
• 13. Selcuk A. The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis. J Chemother 2021; 33(6):390-399.
• 14. Ministry of Health, Health Statistics Yearbook, ISBN: 978-975-590-792-5. 2019; 140-145, 212,214.
• 15. Ministry of Health, Health Statistics Yearbook, ISBN : 978-975-590-792-5. 2019; 148-151. Available at: https://sbsgm.saglik.gov.tr/Eklenti/40564/0/saglik-istatistikleri-yilligi-2019pdf.pdf and Sakarya Province Health Directorate Data.
• 16. Kose A, Colak C. Knowledge and awareness of physicians about rational antibiotic use and antimicrobial resistance before and after graduation: A cross-sectional study conducted in Malatya province in Turkey. Infect Drug Resist. 2021;14:2557-2568.
• 17. Patel A, Pfoh ER, Misra Hebert AD et al. Attitudes of high versus low antibiotic prescribers in the management of upper respiratory tract infections: a mixed methods study. J Gen Intern Med. 2020; 35(4):1182-1188.
• 18. With K de, Allerberger F, Amann S et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection. 2016; 44, 395-439.
• 19. Eilermann K, Halstenberg K, Kuntz L. The effect of expert eedback on antibiotic prescribing in pediatrics: experimental evidence. Medical Decision Making. 2019; 39(7), 781-795.
• 20. Gerber JS, Prasad PA, Fiks AG et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309(22):2345–52. 21. Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJ. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ. 2004; 329(7463):431.