1. 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

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

3. 3 Utilization and expenditures for prescription drugs in Slovenia in 2001 - 15

4. 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

5. 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

6. Consumption of AB in Slovenia 1995 - 1999 + 24 %

7. 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

8. 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

9. 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)

10. Results: Use of AB in 1995 - 2015 1999 - 2014: 32 % decrease (in DID)

11. Expenditures for AB in 2001 – 14 (EUR) Savings 2003 – 14: 11 million € (- 49 %) Investments:325 000 €

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

13. Use of AB in OECD countries in DDD in 2013

14. Amoksicilin/klav.k. Use of AB in 1995 - 2014 amoksicilin makrolidi kinoloni penicilin Co-Amoxiclav Amoxicillin Penicillin Macrolides Quinolones TMP/SMX

15. Use of AB in 1995 – 2014 and prescribing restrictions

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

17. QI – Prevalence of recipients in regions in 2014

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

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

20. OECD QI in one region in 2014 ZD Mb

21. Resistance of S. pneumoniae to macrolides 20012002200320042005200620072008200920102011201220132014 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 (%)424442 4447505456 58 6059

22. Resistance of E. coli to fluoroquinolones

24. Thank you for your attention!