EVALUATION OF ANTIBIOTIC CONSUMPTION OF POPULATION AND ANTIBIOTIC PRESCRIBING PRACTICES IN PRIMARY HEALTH CARE SERVICES IN TURKEY IN COMPARISON TO OECD COUNTRIES

Öz

In this study, we aimed to evaluatethe antibiotic consumption in population and antibiotic prescribing practices in primary healthcare in Turkey in comparison to the OECD countries.This is a database analysis on the OECD Health Data and WHO European Network of Antimicrobial Drugs Consumption database. Antibiotic consumption volume was given as DID (daily dose defined per 1000 people). Total antibiotic consumption in Turkey was 41.1 DID in 2013, which decreased to 35.5 DID and 31.0 DID in 2017 and 2018, respectively. Among OECD countries, Turkey had the highest antibioticconsumption in 2013, which showed a 24.6% decrease in 2018. Consumption of beta-lactam antibiotics in Turkey increased from 43.9% to 47% between 2013 and 2017, while that of cephalosporin decreased from 32.1% to 26.4%. Only 41.3% of antibiotics consumed in Turkey are prescribed in primary health care services, which is the lowest among OECD countries. In conclusion, Turkey is still among the countries with the highest antibiotic consumption in OECD. However, there is a significant decrease in antibiotic consumption in Turkey since 2016, along with an increase in the consumption of "first-line" antibioticsand a decrease in consumption of "second-line" antibiotics. These promising findings might be the result of measures taken at national level.

Anahtar Kelimeler

• Anti-bacterial agents
• drug resistance
• bacterial
• OECD
• primary health care
• Turkey

TÜRKİYE’DE ANTİBİYOTİK TÜKETİM MİKTARININ VE BİRİNCİ BASAMAK SAĞLIK HİZMETLERİNDE ANTİBİYOTİK REÇETELEME UYGULAMALARININ OECD ÜLKELERİ İLE KARŞILAŞTIRMALI OLARAK DEĞERLENDİRİLMESİ

Öz

Bu çalışmanın amacıTürkiye’de antibiyotik tüketim miktarının ve antibiyotik reçeteleme uygulamalarının Ekonomik Kalkınma ve İşbirliği Örgütü (OECD) ülkeleri ile karşılaştırmalı olarak değerlendirilmesidir. Bu çalışma, OECD Sağlık Verileri ve Dünya Sağlık Örgütü (DSÖ) Avrupa Antimikrobiyal İlaçlar Tüketim Ağı veritabanları üzerinden Türkiye ve OECD ülkelerindeki antibiyotik tüketim ve reçeteleme verisinin karşılaştırmalı analizidir. Antibiyotik tüketim hacmi, DID (her 1000 kişi için tanımlanmış günlük doz)olarak verilmiştir. Türkiye’nin 2013’de 41.1 DID olan toplam sistemik antibakteriyel ilaç tüketim hacmi, 2017 ve 2018 yıllarında sırasıyla 35.5 DID ve 31.0 DID düzeyine düşmüştür. Türkiye OECD ülkeleri arasında, 2013’de en yüksek antibiyotik tüketimine sahipken, 2018’de bu tüketimde %24.6’lık bir düşüş göstermiştir. DSÖ veritabanında Türkiye’de beta-laktam grubu antibiyotiklerin kullanım oranı 2013-2017 yılları arasında %43.9’dan %47’ye çıkarken, sefalosporinlerin kullanım oranı %32.1’den %26.4’e düşmüştür. Türkiye’de tüketilen toplam antibiyotik miktarının sadece %41.3’ünün birinci basamak sağlık hizmetlerinde reçetelenmektedir, bu değer tüm OECD ülkeleri arasındaki en düşük orandır. Sonuç olarak, Türkiye OECD ülkeleri arasında hala en yüksek antibiyotik tüketim miktarına sahip ülkeler arasındadır. Ancak, özellikle 2016 yılından itibaren Türkiye’de antibiyotik tüketim miktarında belirgin düşüş olması ve “birinci sıra” antibiyotikler tüketiminde artışla birlikte “ikinci sıra” antibiyotiklerin tüketiminde azalma olması dikkat çekicidir. Bu olumlu ve umut verici bulguların, ulusal düzeyde alınan tedbirlerin sonucu olduğu düşünülmektedir.

Anahtar Kelimeler

• Anti-bakteriyel ajanlar
• bakteriyel direnç
• birinci basamak sağlık hizmetleri
• OECD
• Türkiye

Kaynakça

1. 1. Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013; 13:1057-1098.
2. 2. Klein EY, Van Boeckel TP, Martinez EM, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA 2018; 115:E3463-3470.
3. 3. WHO Report on Surveillance of Antibiotic Consumption. 2016-2018 Early Implementation. https://apps.who.int/iris/bitstream/handle/10665/277359/9789241514880-eng.pdf?ua=1 Erişim tarihi: Eylül 2020.
4. 4. Versporten A, Bolokhovets G, Ghazaryan L, et al. WHO/Europe-ESAC Project Group. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis 2014; 14:381-387.
5. 5. WHO Regional Office for Europe. Turkey takes strong action to reduce antibiotic consumption and resistance. Copenhagen: World Health Organization Regional Office for Europe; 2017. http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobialresistance/news/news/2017/11/turkeytakes-strong-action-to-reduce-antibioticconsumption-and-resistance. Erişim tarihi: Eylül 2020.
6. 6. Aksoy M, Alkan A, İşli F. Rational drug use promotional activities of Ministry of Health. Turkiye Klinikleri J Pharmacol-Special Topics 2015; 3:19-26.
7. 7. WHO/EMP/MAR/2012.3. Essential medicines and health products. The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. https://www.who.int/medicines/areas/rational_use/en/. Erişim tarihi: Eylül 2020.
8. 8. WHO. Global action plan on antimicrobial resistance, 2015. https://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/. Erişim tarihi: Eylül 2020.

9. 9. The OECD Health Database 2020. https://stats.oecd.org/Index.aspx?ThemeTreeId=9. Erişim tarihi: Eylül 2020.
10. 10. WHO Regional Office for Europe Antimicrobial Medicines Consumption (AMC) Network, AMC data 2011–2017. Copenhagen: WHO Regional Office for Europe; 2020. Licence: CC BY-NC-SA 3.0 IGO. https://www.euro.who.int/en/publications/abstracts/who-regional-office-for-europe-antimicrobial-medicines-consumption-amc-network.-amc-data-20112017-2020. Erişim tarihi: Eylül 2020.
11. 11. WHO Collaborating Centre for Drug Statistics Methodology. International language for drug utilization research. ATC/DDD. https://www.whocc.no/. Erişim tarihi: Eylül 2020.
12. 12. Prah J, Kizzie-Hayford J, Walker E, et al. Antibiotic prescription pattern in a Ghanaian primary health care facility. Pan Afr Med J 2017; 28:214.
13. 13. Grosso G, Marventano S, Ferranti R, et al. Pattern of antibiotic use in the community: νon-adherence and self-prescription rates in an Italian urban population. Mol Med Rep 2012; 5:1305-1310.
14. 14. Kaur A, Bhagat R, Kaur N, et al. A study of antibiotic prescription pattern in patients referred to tertiary care center in Northern India. Ther Adv Infect Dis 2018; 5:63-68.
15. 15. El-Kholey KE, Wali O, Elkomy A, et al. Pattern of antibiotic prescription for oral implant treatment among dentists in Saudi Arabia. Implant Dent 2018; 27:317-323.
16. 16. Segura-Egea JJ, Martín-González J, Jiménez-Sánchez MDC et al. Worldwide pattern of antibiotic prescription in endodontic infections. Int Dent J 2017; 67:197-205.
17. 17. Mazzaglia G, Greco S, Lando C, et al. Adult acute upper respiratory tract infections in Sicily: pattern of antibiotic drug prescription in primary care. J Antimicrob Chemother 1998; 41:259-266.
18. 18. Sayılı U, Aksu Sayma Ö, Vehid S, et al. Comparison of health Indicators and Health Expenditures of Turkey and OECD Countries. Online Türk Sağlık Bilimleri Dergisi. 2017; 2:1-12.
19. 19. İşli F, Aksoy M, Emre Aydıngöz S, et al. Rational use of antibiotics by family physicians in turkey during primary healthcare service: a cross-sectional analysis through the Prescription Information System. TJFMPC 2020; 14:87-95.
20. 20. Roque F, Herdeiro MT, Soares S, et al. Educational interventions to improve prescription and dispensing of antibiotics: a systematic review. BMC Public Health 2014; 14:1276.
21. 21. Butler CC, Simpson SA, Dunstan F, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ 2012; 344:d8173.
22. 22. Ho MJ, Venci J. Improving the success of mailed letter intervention programs to influence prescribing behaviors: a review. J Manag Care Pharm 2012; 18:627-649.
23. 23. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005; 4:CD003539.
24. 24. Rubin MA, Bateman K, Alder S, et al. A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community. Clin Infect Dis 2005;40:546-553.
25. 25. Enriquez-Puga A, Baker R, Paul S, et al. Effect of educational outreach on general practice prescribing of antibiotics and antidepressants: a two-year randomised controlled trial. Scand J Prim Health Care 2009; 27:195-201.
26. 26. Mandryk JA, Mackson JM, Horn FE, et al. Measuring change in prescription drug utilization in Australia. Pharmacoepidemiol Drug Saf 2006; 15:477-484.
27. 27. Légaré F, Labrecque M, LeBlanc A, et al. Training family physicians in shared decision making for the use of antibiotics for acute respiratory infections: a pilot clustered randomized controlled trial. Health Expect 2011; 14:96-110.
28. 28. Chazan B, Turjeman RB, Frost Y, et al. Antibiotic consumption successfully reduced by a community intervention program. Isr Med Assoc J 2007; 9:16-20.
29. 29. Finkelstein JA, Huang SS, Kleinman K, et al. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics 2008; 121:e15-23.