| Abstract | Cilj ovoga retrospektivnog istraživanja bio je prikazati potrošnju antibiotika propisanih u ugovornim ordinacijama dentalne medicine u Republici Hrvatskoj u petogodišnjem razdoblju. U razdoblju od početka 2015. godine do kraja 2019. godine prikupljeno je i obrađeno 1.535.139 podataka (e-Recepata) dobivenih s Centralnoga zdravstvenog informatičkog sustava Republike Hrvatske (CEZIH). Elektronički recepti sadržavali su podatke o propisanom antibiotiku, broju pakiranja te o poštanskom uredu ordinacija. Za prikaz potrošnje lijekova koristila se formula DDD/TSD (definirana dnevna doza/1000 stanovnika na dan), koja se izračunava: ukupna potrošnja mjerena u DDD-ima × 1000/365 × broj stanovnika. U toj se formuli kao broj stanovnika uzeo broj stanovnika dobiven od Državnog zvoda za statistiku, za godinu na koju se rezultati odnose. Potrošnja antibiotika porasla je od 1,98 DDD/TSD u 2015. godini na 2,10 DDD/TSD u 2019. godini. Zabilježeni su porast potrošnje amoksicilina s klavulanskom kiselinom (1,4 DDD/TSD u 2015. na 1,57 DDD/TSD u 2019.) i metronidazola (0,05 DDD/TSD u 2015. na 0,060 DDD/TSD u 2019., p < 0,05) te pad potrošnje klindamicina (0,11 DDD/TSD u 2015. na 0,10 DDD/TSD u 2019.) i cefaleksina (0,05 DDD/TSD u 2015. na 0,02 DDD/TSD u 2019., p < 0,05). U urbanoj sredini potrošnja je bila veća nego u ruralnoj (p < 0,05). Najčešća dijagnoza za koju se propisivao antiobiotik bila je periapikalni proces bez sinusa (20%). U gotovo 30% slučajeva antibiotici su propisivani za dijagnoze kod kojih nema indikacija, S obzirom na ukupnu potrošnju antibiotika u Republici Hrvatskoj u promatranom razdoblju, udjel potrošnje antibiotika propisanih u ugovornim ordinacijama dentalne medicine iznosio je oko 10% u petogodišnjem razdoblju. |
| Abstract (english) | Aim: The aim of this research was to investigate antibiotics consumption issued in contracted dental offices in the Republic of Croatia in the period of five years.
Materials and methods: This is a retrospective study. The data on the prescription of antibiotics in contracted dental practices were obtained from Croatian Health Insurance Fund (CHIF). Contracted dental practices are those with a legal
agreement with the Croatian Health Insurance Fund. All prescription drugs by primary health care dental doctors, that have a contract with CHIF for the provision of health care, are recorded in the Central Health Information System of the Republic of Croatia (CEZIH). Each ePrescription contains a set of data about the prescribed drug (such as the drug name, active substance, dose, Anatomical Therapeutic Chemical Classification of the drug), the indication for the drug's use, patient identifier, date of prescription, the identifier of the doctor who prescribed the drug, and the identifier of the pharmacist's
identifier who dispensed the drug. Accurate information on prescribed drugs was obtained from individual prescriptions, from which consumption was calculated using the number of defined daily doses per 1000 population per day (DID). Defined Daily Dose (DDD) is the average daily dose of a drug when used for its main indication in adults. DDD is assigned to drugs with an Anatomical Therapeutic Chemical (ATC) code and is determined based on the international use of the drug. Each ePrescription includes a diagnosis (indication) for the prescription of the drug. Diagnoses are encoded and
classified according to the International Classification of Diseases and Related Health Problems (ICD codes). The classification of diseases can be defined as a system of categories assigned to specific diseases based on established criteria. ICD is a medical classification containing codes for diagnoses, signs, symptoms, and causes of injuries, published by the World Health Organization. The population estimate of the Republic of Croatia was obtained from the Croatian Bureau of Statistics. In Croatia, it is possible to obtain a private prescription (where the individual bears the cost) or a prescription a cost of which is covered by the Croatian Health Insurance Fund. Private prescriptions were not included in this study, and they accounted for 11% of the total drug consumption, unlike the total drug consumption covered by the CHIF, which was 89%. All trends were examined using linear regression and the Spearman correlation coefficient. A comparison of the number of issued drugs between rural and urban populations was made using the Chi-square test. Statistical testing was conducted at a significance level of 95% (p < 0.05). The results of statistical analysis are presented in tables and graphs.
Results: The consumption of antibiotics during the observed period from 2015 to 2019 increased by 6%. Throughout this period, the most commonly prescribed antibiotic was amoxicillin with clavulanic acid, followed by amoxicillin, clindamycin,
metronidazole and cephalexin and it accounted for a total of 80% of all prescribed antibiotics during that period. The highest consumption of antibiotics was for the combination of amoxicillin with clavulanic acid, followed by amoxicillin, clindamycin,
metronidazole, and cephalexin. The consumption of amoxicillin with clavulanic acid in 2015 was 1.4 DID and has consistently increased each year. Over the observed period, consumption grew by 11.4%, reaching 1.57 DID in 2019 (p < 0.05). Concurrently, metronidazole consumption increased by 15.5% (p < 0.05), while amoxicillin consumption decreased by 6% from 0.31 DID to 0.29 DID (p < 0.05). The consumption of clindamycin decreased by 9.9%, amounting to 0.10 DID in 2019, and cephalexin consumption decreased by 42.7%, reaching 0.02 DID in 2019 (p < 0.05). Throughout the observed period, 877,673 prescriptions were issued to women and 705,415 to men. The data indicate that more antibiotics were prescribed to females (p < 0.05). The average age was 49.6 years, with a median of 51. The highest number of prescriptions, expressed in defined daily doses, was for the age group 18–65 years, with a 0.8% increase during the
observed period. The number of prescriptions significantly increased by 23.9% in the age group 80+ (p < 0.05) and decreased by 16.2% for the age group 7–17 years (p < 0.05). In the age group 0–6, there was a 3.1% decrease, although it was not statistically significant. The most common diagnoses requiring antibiotic prescriptions in the conducted research
were periapical abscess without sinus involvement, diseases of pulp and periapical tissues, chronic inflammation of the apical periodontium, pulp necrosis, acute inflammation of the apical periodontium of pulpal origin, pulpitis, acute periodontal
inflammation, inflammatory conditions of the jaw, retained dental root, acute gingival inflammation, making up 80% of all diagnoses for which antibiotics were prescribed in the specified period. With regard to the total consumption of antibiotics in the Republic of Croatia in the observed period, the antibiotic consumption rate in contracted dental practices amounted to about 10% of national consumption in the five-year period.
Conclusion: Based on the data from this study, from 2015–2020, regarding antibiotic consumption we can conclude that the consumption of antibiotics prescribed by public health general dentists has increased. The most prescribed antibiotics were
amoxicillin with clavulanic acid, amoxicillin, clindamycin, metronidazole and cephalexin. Antibiotics were prescribed for clinical diagnoses for which antibiotics are not indicated or the indication was unclear. Additional education for dentists regarding antibiotics use is necessary as well as raising awareness among both dentists and patients on the growing global problem of antimicrobial resistance. Development of national guidelines for antibiotic use is essential. |
