1. Danijela Daus-Šebeđak
OUTPATIENT ANTIBIOTIC CONSUMPTION FOR URINARY INFECTIONS IN CROATIA : WHAT CAN BE LEARNED FROM UTILIZATION TRENDS
Danijela Daus-Šebeđak
Željko Vojvodić

2. Introduction
Urinary tract infections (UTIs) are frequent occurrence in routine work of both family doctors and hospital specialists
The second most frequent indication for antibiotics, after respiratory infections. The predominant pathogens are Escherichia coli (75-90% of cases), Staphylococcus saprofiticus (5-15%), followed by Proteus mirabilis, Klebsiella spp i enterococci (1).

3. Aims and purpose
The aim of this study was to determine quantities of antibacterial utilization for urinary tract infections in Croatia between and 2014
To assess conformity between utilization trends and guideline recommendations, and to evaluate the impact of antibiotic consumption on antimicrobial resistance.

4. Methods of data collecting
Antibiotic utilization data were obtained from annual reports of both Croatian Drug Agency and Croatian Academy of Medical Sciences. Antibiotic consumption was expressed in DDD/1000 inhabitants/day (DDD TID)
Antimicrobial resistance was analysed for E. coli, E. faecalis, E. faecium, P. aeruginosa, Klebsiella spp., P. mirabilis. Data were summarized by means of descriptive statistics.The study - routinely collected data

5. Results
- average annual incerase or decrease of trends for each individual antibiotic used for urinary tract infections -frequency of UTIs in Croatia 49,7/ 1000 (2006), total antibiotic consumption 23,51 DDD TID (2014), „urinary ABs” 3,19 DDD (13,57%) (2014) -overall use of ABs for UTIs decreased by 4,8% (from 3,35 in 2005 to 3,19 in 2014) trends of individual agents varied: quinolones and nitrofurantoin increased by 32,3% and 86,05%, co-trimoxazole decreased by 57%

6. Pharmacological consumption of antibiotics in DDD/TID to treat UTI

7. Quinolone's consumption in Croatia in period 2005-2014.

8. Resistence of E. coli  to coamoxiclav, cotrimoxazole, ciprofloxacine i nitrofurantoine in Croatia, 2008 – 2014.

9. Implications – for discussion!
Increasing trend of use of fluoroquinolones contributes substantially to bacterial resistance, while the use of nitrofurantoin helps to halt the spread of resistance
What is needed : clear and precisely defined instructions on antimicrobial treatment
 more informations about medicaments and their (un)efficacy  (resistence)
  eg. fosfomicine, pivmecilinam tbl.400 mg,
 trimetoprime 200 mg