Prescribing of antibiotics in Slovenia in the period 1999 – 2015 Jurij Fürst ZZZS Slovenia 21 th EUMASS Congress and 4 th Congress of Medical Assessors in the Republic of Slovenia Ljubljana June 9 – 11, 2016

Expenditures for prescription drugs per capita in 2011 in USD PPP Source OECD Health Data 2013

3 Utilization and expenditures for prescription drugs in Slovenia in

Challenges in prescribing of antibiotics (AB – ATC J01) Rising resistance worldwide Decline in AB research and drug development programs Ecological pressures Rising costs of infectious diseases

Activities - campaigns EU: Antibiotic awareness day France: „Keep antibiotic working“ campaign –„Les antibiotiques c'est pas automatique“ Training programs in communication skills Internet based training tools Quality indicators

Consumption of AB in Slovenia %

Institutions (organizers), stakeholders and activities National Committee for the rational use of antibiotics at the Ministry of Health: a national coordinating body responsible for enhancing the prudent use of antimicrobials: –AB awareness day –Workshop in the region(s) with the highest use of antibiotics Infectologists: –Guidelines for treatment of infectious diseases (2002, 2013) –Workshops on rational prescribing of AB –Symposiums on AB once a year Medical School of Ljubljana University: –Workshops on rational prescribing of AB for specializing GPs

Institutions (organizers), stakeholders and activities ZZZS (HII): –Prescribing restrictions –Audits –Workshops in primary health centres –Informative budget targets for prescribing drugs –The drug bulletin Recept –Flyers for lay public –Booklet „My child has a fever“ –Project Quality of prescribing for GPs

Project Quality of prescribing 3 indicators for antibiotics (since 2011): –Intensity of treatment: No of DDD of AB / recipient –Prevalence of recipients: No. of recipients of AB / 1000 recipients of prescriptions) –Broad spectrum vs narrow spectrum AB (OECD QI): cephalosporins + quinolones total AB (J01)

Results: Use of AB in : 32 % decrease (in DID)

Expenditures for AB in 2001 – 14 (EUR) Savings 2003 – 14: 11 million € (- 49 %) Investments: €

Use of AB in Europe in DDD in 2014* * ECDC data

Use of AB in OECD countries in DDD in 2013

Amoksicilin/klav.k. Use of AB in amoksicilin makrolidi kinoloni penicilin Co-Amoxiclav Amoxicillin Penicillin Macrolides Quinolones TMP/SMX

Use of AB in 1995 – 2014 and prescribing restrictions

Poraba AB v letu 2014 po statističnih regijah* * Podatki NIJZ 2015

QI – Prevalence of recipients in regions in 2014

QI Prevalence of recipients in one region in 2014 *red: health centres, blue: private GPs

OECD – QI* in regions in 2014 *share of cephalosporins and quinolones in J01 (%)

OECD QI in one region in 2014 ZD Mb

Resistance of S. pneumoniae to macrolides Macrolidi3,132,812,983,003,022,302,432,222,081,861,721,561,551,54 Azitromicin1,321,231,261,271,331,081,211,201,171,050,990,900,940,90 Delež azitromicina (%)

Resistance of E. coli to fluoroquinolones

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