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Antibioticconsumptionandmanagementat.pdf
Macedonian pharmaceutical bulletin, 65 (2) 11 - 21 (2019)
ISSN:
UDC: 615.33.03(497.733)”2016/2018”
DOI: 10.33320/maced.pharm.bull.2019.65.02.002
Original scientific paper
Antibiotic consumption and management at
Kocani General Hospital – Annual report
Nada Ilieva, Milena Nikolova, Donka Pankov, Maja Simonoska Crcarevska,
Kristina Mladenovska, Dushko Shalabalija, Ljubica Mihailova, Olga Gigopulu,
Marija Glavas Dodov*
Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje,
R. North Macedonia
Received: April 2019; Accepted: June 2019
Abstract
The aim of the study was to get detailed insight into the antibiotic consumption trends in the three year period (2016-2018) in
Kocani Hospital, to identify the most often prescribed antibiotics and to determine whether the treatment of given diagnosis was in
accordance with the official guidelines. The survey covered all pediatric and infant patients admitted to the pediatric ward. Patients’ data
included gender, age, diagnosis, antibiotic used and doses. The majority of admitted patients were in the age group of 0-1 (27.48%,
25.94% and 30.77% for 2016, 2017 and 2018, accordingly) followed by age group of 1-2 years (20.86%, 22,0% and 23.83% for 2016,
2017 and 2018, consequently) and 2-3 years (16.06%, 16.1% and 14.63% for 2016, 2017 and 2018, consequently) .The most frequent
diagnosis was acute tonsillitis which was determined in ~21% of patients, pneumonia without complications in ~18% and acute
bronchitis in ~16% of patients in the period 2016-2018. Results from conducted survey identified high prescription rate and use of
antibiotics predominantly ceftriaxone (82.58%, 81.05% and 50.85% in 2016, 2017 and 2018, respectively) contrary to official
recommendations and evidences based on clinical data for treatment of the diagnoses in question. So, it is foreseeable to conclude that
there is urgent need for restrictive and educational measures i.e. to strength the surveillance and monitoring of antibiotic prescription and
usage and hence to promote awareness for rational use of antibiotics on all health-care levels.
Keywords: antibiotic prescription, antibiotic consumption, pediatric wards, annual report
Introduction
Antibiotics also known as antimicrobial drugs are
commonly used for treatment of bacterial infections.
Antibiotics are one of the most powerful medicines that
have saved great number of people’s life, despite the fact
that in Greek, the translation of their name means anti
bios (anti life). They inhibit or prevent the growth of
bacteria, fungi and some parasites, but they cannot kill
viruses. People misused antibiotics during the 20 th
century
and this irrational consumption of antibiotics has resulted
with occurrence of so called “resistant bacteria”.
Antimicrobial resistance occurs when bacteria and other
microbes adapt and become less responsive to treatment.
The rapid rise and replication of antimicrobial resistant
organisms worldwide is a problem of huge dimensions.
The antimicrobial resistance causes about 700,000 deaths
annually around the world, and each country is potentially
affected. The figure can rise to 10 million till 2051. The
root causes of this problem are multifactorial. The
emergence of antibiotic resistance is highly related to
their inadequate use (Arnold et al., 2011; Laxminarayan
et al., 2013; Leuthaner et al., 2013). Studies showed that
__________________
N. Ilieva, M. Nikolova, D. Pankov, M. Simonoska Crcarevska, K. Mladenovska, D. Shalabalija, Lj. Mihailova,
O. Gigopulu, M. Glavas Dodov 12
Maced. pharm. bull., 65 (2) 11 – 21 (2019)
30-60% of the prescribed antibiotics in the hospital sector
are unnecessary, inadequate, or suboptimal (Bergmans et
al., 1997; Kollef, 2001; Kollef and Fraser, 2001; Roberts
et al., 2011).
Prescribing antibiotics and antibiotics misuse,
undoubtedly contribute to the growth of antibiotic
resistant bacteria. Epidemiological studies demonstrate
direct dependence between antibiotics consumption and
the emergence and replication of the resistant hospital
bacteria. The optimal use of antibiotics is crucial in the
healthcare setting, especially in the era when antibiotic
resistance increases and there is a lack of new
antimicrobial development (Arnold et al., 2011;
Laxminarayan et al., 2013; Leuthaner et al., 2013).
Providing reliable and comparable national data about the
consumption of antibiotics is a prerequisite for
understanding of the epidemiology of antibiotic resistance
in Europe since their inadequate use is one of the main
factors responsible for resistance to antibiotics (Arnold-
Lefevre et al., 2013; Goldman et al., 1996; Kollef and
Fraser, 2001; Landman et al., 2002; Lipsitch et al., 2000;
MacDougall and Polk, 2006; Malhota-Kumar et al., 2007;
McGowan, 1983; Paterson, 2006; Ricel, 2008; Shalaes et
al., 1997; Sieve et al., 2013; Thomas et al., 1998; Zillich et
al., 2006).
Having in mind previous, the aim of the study was to
analyze the antibiotic consumption trends in the three year
period (2016-2018) in Kocani Hospital, to identify the
most often prescribed antibiotics and to determine
whether the treatment of given diagnosis was in
accordance with the official guidelines.
Materials and methods
The retrospective survey for prescribing and
consuming antibiotics for the period 2016-2018 (January-
December) was conducted in May, 2019. The survey
covered all pediatric and infant patients admitted to the
pediatric ward. Patients’ data included gender, age,
diagnosis, antibiotic used and doses. The quantity of given
antibiotic as treatment and prophylaxis was coded as a
daily dose - DDD for 1 or more days of prophylactic
treatment. Data were collected from software program
“Moj termin” (My term) and official medical records from
the Kocani Hospital database. The data covered all
hospitalized pediatric patients in the above mentioned
period. However, it has to be emphasized that all data
were available as group data, and were not collected per
patient admitted in pediatric ward of Kocani Hospital.
Obtained data were tabulated in Microsoft Excel®
(Microsoft Corp. Redmond, WA, USA) and were
computed and consequently evaluated using statistical
software STATGRAPHICS Centurion XVI evaluation
(StatPoint technologies Inc., USA).
Table 1. Detailed data related to gender and age of patients admitted in Kocani Hospital pediatric ward for period 2016-
2018 year
2016 2017 2018
age male female male female male female
0-1 78 88 75 70 73 91
1-2 67 59 64 59 58 69
2-3 57 40 48 42 28 50
3-4 25 22 23 27 20 24
4-5 17 12 14 13 8 14
5-6 14 16 12 8 10 12
6-7 7 10 6 9 4 9
7-8 15 9 13 8 11 10
8-9 8 4 9 6 2 2
9-10 7 8 6 7 5 6
10-11 3 4 8 3 5 2
11-12 8 3 5 2 6 3
12-13 2 5 2 4 1 4
13-14 4 2 3 3 2 1
14-15 3 0 3 1 1 0
15-16 4 0 2 1 2 0
16-17 2 1 3 0 0 0
Subtotal 321 283 296 263 236 297
Total 604 559 533
Antibiotic consumption and management at Kocani General Hospital – Annual report 13
Макед. фарм. билт., 65 (2) 11 – 21 (2019)
Table 2. Number of patients by diagnosis admitted in pediatric ward in Kocani Hospital in the period 2016-2018 year
2016 2017 2018
ICD-10-CM code female male total female male total female male total
1 J 00 Acute nasopharyngitis [common cold] 9 8 17 7 4 11 3 10 13
2 J 02 Acute pharyngitis 31 17 48 21 24 45 9 30 39
3 J 03.9 Acute tonsillitis, unspecified 54 73 127 60 57 117 49 58 107
4 J 04.0 Acute laryngitis 7 6 13 5 1 6 1 4 5
5 J 18.0 Bronchopneumonia, unspecified organism 59 52 111 53 47 100 56 42 98
6 J 18.9 Pneumonia, unspecified organism 18 9 27 9 11 20 10 12 22
7 J 20.9 Acute bronchitis, unspecified 47 49 96 49 44 93 32 56 88
8 J 21.8 Acute bronchiolitis due to other specified organisms
4 4
1 1
1 1
9 J 21.9 Acute bronchiolitis, unspecified 28 25 53 28 16 44 19 28 47
10 J 40 Bronchitis, not specified as acute or chronic
(asthma)
2 2
3 3
1 1
11 J 44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
1 4 5
2 2
1 1
12 N 39.0 Acute cystitis 4 2 6 9 1 10 7 1 8
13 N 39.9 Disorder of urinary system, unspecified 2
2 2
2 1
1
14 A 08.0 Rotaviral enteritis 3 1 4 7 2 9 3 3 6
15 A 09 Infectious gastroenteritis and colitis, unspecified 4 2 6 2 3 5 4 3 7
16 D 69.0 Allergic purpura 1 1 2 1
1 1 1 2
17 B 34.9 Viral infection, unspecified
2 2
1 1
1 1
18 F 31.7 Bipolar disorder, currently in remission 1
1 2
2 1
1
19 G 40.90 Epilepsy, unspecified, not intractable 2 1 3 1
1 1
1
20 G 80.03 Athetoid cerebral paralysis 1
1
0 1
1
21 H 65.9 Unspecified nonsuppurative otitis media 1 1 2 2 3 5 1 2 3
22 I 47.9 Paroxysmal tachycardia, unspecified 2
2
0 1
1
23 K 12.1 Other forms of stomatitis
1 1
1 1
1 1
24 K 29.9 Gastroduodenitis, unspecified 1
1 2
2 1
1
25 K 52.9 No infective gastroenteritis and colitis,
unspecified 10 8 18 6 12 18 10 11 21
26 K 56.0 Paralytic ileus
1 1
1 1
1 1
27 L 04.0 Acute lymphadenitis of face, head and neck
3 3
1 1
2 2
28 L 20.9 Atopic dermatitis, unspecified
2 2 3
3
1 1
29 L 23.9 Allergic contact dermatitis, unspecified cause
3 3 3
3
4 4
30 L 27.9 Dermatitis due to unspecified substance taken
internally
1 1
2 2
1 1
N. Ilieva, M. Nikolova, D. Pankov, M. Simonoska Crcarevska, K. Mladenovska, D. Shalabalija, Lj. Mihailova,
O. Gigopulu, M. Glavas Dodov 14
Maced. pharm. bull., 65 (2) 11 – 21 (2019)
31 L 50.0 Allergic urticaria
2 2
1 1
1 1
32 L 50.9 Urticaria, unspecified 5
5 4 4 8
7 7
33 M 60.9 Myositis, unspecified
1 1
1 1
1 1
34 P 39 Other infections specific to the perinatal period 3
3
2 2 4
4
35 R 10.0 Acute abdomen 1
1
3 3
1 1
36 R 10.9 Unspecified abdominal pain 1
1
1 1
2 2
37 R 11 Nausea and vomiting 21 2 23 20 10 30 20 8 28
38 R 55 Syncope and collapse 1
1
2 2
1 1
39 R 56.9 Unspecified convulsions 2
2
1 1 1
1
40
T 39.9 Poisoning by, adverse effect of and under
dosing of unspecified no opioid analgesic, antipyretic and antirheumatic
1
1
1 1
1 1
Total 321 283 604 296 263 559 236 297 533
Results and discussion
The overall number of patients admitted at the
pediatric ward of Kocani Hospital in the study period
2016-2018 was 1696. Detailed data related to gender and
age are given in Table 1.
One-way ANOVA (p<0.05) indicated that there was
no statistical significant difference between total number
of patients, as well as male and female patients in each
year of studied period. However, it pointed that there is
statistical difference between age groups. From results
presented in Table 1, it can be clearly seen that the
majority of admitted patients were in the age group of 0-1
(27.48%, 25.94% and 30.77% for 2016, 2017 and 2018,
accordingly) followed by age group of 1-2 years (20.86%,
22.0% and 23.83% for 2016, 2017 and 2018,
consequently) and 2-3 years (16.06%, 16.1% and 14.63%
for 2016, 2017 and 2018, consequently). Overall results
indicated that the number of patients decreased with age.
From detailed results presented in Table 2, it can be
seen that the most frequent diagnosis was acute tonsillitis
(code J03.9 according to ICD-10-CM (International
Classification of Diseases, Tenth Revision, Clinical
Modification)) which was determined in 21.03%, 20.93%
and 20.08% of patients in 2016, 2017 and 2018,
accordingly, followed by pneumonia without
complications (ICD-10-CM code J18.0) in 18.38%,
17.89% and 18.39% and acute bronchitis (ICD-10-CM
code J20.9) in 15.89%, 16.64% and 16.51% of patients in
2016, 2017 and 2018, consequently.
Total quantity of antibiotics ordered from hospital
pharmacy and used (2016-2018) in pediatric ward of
Kocani Hospital is given in Table 3. Results pointed that
97% of ordered antibiotics were used. The most common
used antibiotic was ceftriaxone with a share of 82.58%,
81.05% and 50.85% in 2016, 2017 and 2018 year,
accordingly. The lower share of ceftriaxone in 2018 is
related to the significant increase of ampicillin usage
compared to previous years (32.58% in 2018 vs 1.04% in
2017 and 0% in 2016 year). In accordance were the
findings of Quaak et al. (2018) for the antibiotic use in
secondary care urban teaching hospital in Rotterdam, the
Netherlands. Namely, in the surveyed period 2010-2015
most commonly used antibiotics were cefotaxime and
ceftriaxone, and hence their use showed a significant
decrease during years due to the increase of amoxicillin
and amoxicillin/clavulanic acid usage. The situation was
similar in pediatric wards in hospitals in Latvia where a
one-day cross-sectional point prevalence survey
conducted in November, 2012 indicated that the third-
generation cephalosporins were among the mostly used
antibiotic groups for pediatric patients with share of
cefazolin and ceftriaxone of 24.2% and 21%, respectively
(Sviestina and Mozgis, 2014). In the study of Porta et al.
(2012), conducted in 2009 in UK, Italy and Greece, 37%
of all antibiotics were penicillin b-lactam antibacterials
with type of b-lactam varied between hospitals. In UK
hospitals use of co-amoxiclav prevailed, while in Italy and
Greece hospitals ceftriaxone/cefotaxime and
cefuroxime/ceftriaxone, respectively were dominantly
used. Such high share of ceftriaxone use might be
explained with social acceptance of the common believe
that intravenous antibiotics are “stronger” than oral ones
(Sviestina and Mozgis, 2014).
Usage of antibiotics per given diagnosis is presented
in Tables 4, 5 and 6 for 2016, 2017 and 2018, accordingly.
Antibiotic consumption and management at Kocani General Hospital – Annual report 15
Макед. фарм. билт., 65 (2) 11 – 21 (2019)
Table 3. Quantity of ordered and used antibiotics in pediatric ward of Kocani Hospital 2016-2018 year
2016 2017 2018
ordered used ordered used ordered used
Amp. Ampicillin á 1.0 g 0 0 60 27 1650 1644
Amp. Ceftriaxone á 1.0 g 2080 2029 2129 2113 2640 2566
Sir. Cephalexin á 250 mg/5 ml 6 5 1 1 2 0
Caps. Cephalexin á 500 mg 48 48 70 60 192 192
Sir. Amoxicillin + clavulanic acid á
4oo mg/ 57 mg/5 ml 37 35 65 59 55 53
Sir. Cefaclor á 25o mg/5 ml 19 15 30 30 27 25
Amp. Cefotaxime á 5oo mg 270 270 220 210 325 306
Amp. Amikacin á 5oo mg 30 30 73 64 130 130
Amp. Gentamicin á 40 mg/2 ml 10 0 50 43 80 80
Amp. Gentamicin á 20 mg/2 ml 30 25 5 0 50 50
Having in mind that most commonly in the period
2016-2018 patients admitted in pediatric ward of Kocani
Hospital were diagnosed with acute tonsillitis, pneumonia
without a complications and acute bronchitis it is
normally to expect that most of the prescribed DDD of
antibiotics were related to these conditions. 36.55%,
39.56% and 23.6% of all DDD of prescribed antibiotics in
2016, 2017 and 2018 were related to pneumonia without
complications and in case of acute tonsillitis 18.19%,
19.33% and 23.58% and acute bronchitis 15.06%, 11.2%
and 14.36% of all DDD of antibiotics were prescribed in
2016, 2017 and 2018, accordingly. Respiratory infections
were also most common diagnosis in pediatric wards in
hospitals in Latvia, where 34.7% and 13.9% of pediatric
patients were diagnosed with lower and upper respiratory
tract infections (Sviestina and Mozgis, 2014). However,
in the study of Patel et al. (2012) in UK, Italy and Greece
hospitals, antibiotics were most commonly used for
surgical prophylaxis (21%) with differences between
surveyed hospitals (2% and 31% in two UK hospitals
(Center 1 and 2), and 18% in Italy and 31% in Greece
surveyed hospital. In UK Center 1 and Italy hospital the
main indication for antibiotic treatment was lower
respiratory tract infection in 17% and 37% of children,
respectively.
It can be seen that patients diagnosed with Acute
tonsillitis (ICD-10-CM code J03.9) in 2016 and 2017
were most frequently treated with Amp. Ceftriaxone á 1.0
g (93.06% in 2016 and 90.87% in 2017 of DDD of
prescribed antibiotics for the J03.9). However, in 2018
only 37.14% of patients were treated with this antibiotic
vs 58.54% which were treated with Amp. Ampicillin á 1.0
g. The treatment was prescribed empirically in all cases
(no microbiology analysis were required and conducted).
According to guidelines for medical care of tonsillitis and
pharyngitis in pediatric population issued by Ministry of
healthcare of Republic of North Macedonia
(http://zdravstvo.gov.mk/wp-content/uploads/2015/08/
Tonzilitis-i-faringitis-kaj-deca1.pdf) if infection is caused
by group A streptococci it should be treated with
penicillin 70 mg/kg daily (100,000 d/kg/24h), or in
patients allergic to penicillin with cephalexin 50
mg/kg/24h, in two doses for 10 days. Short-term
cephalosporin therapy (2 to 6 days) may be effective but
is associated with more side effects. Shorter therapy may
be used if there is difficulty in prolonging a child's
antibiotic treatment. Macrolides are used to treat
tonsillitis only in patients with penicillin or cephalosporin
allergy.
Patients diagnosed with pneumonia without
complications (ICD-10-CM code J18.0) were treated with
Amp. Ceftriaxone á 1.0 g in 79.37%, 81.88% and
74.76% of DDD of prescribed antibiotics in 2016, 2017
and 2018 year, accordingly. Similar was the situation for
treatment of bronchopneumonia in Pediatric Clinic in
Sarajevo where first (cefazolin in 40.4% of patients) and
third generation of cephalosporins (31.7% of patients with
most often used ceftazidime followed by ceftriaxone and
cefixime) and penicillin antibiotics (25% of patients)
were commonly used (Zec et al., 2016). According to the
guidelines for medical care of pneumonia in childhood
issued by the Ministry of healthcare of Republic of North
Macedonia (http://zdravstvo.gov.mk/wp-content/uploads/
2015/08/Pnevmonii-vo-detstvoto.pdf) medicine of choice
in preschool children as first-line therapy is amoxicillin
40-50mg/kg/day in 3 doses for 7 days. The same
recommendations are for treatment of pneumonia in
school children, but having in mind that Mycoplasma and
Chlamydia infections are very often in this group it might
be considered that the treatment may be based on
1 6
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Table 4. Usage of antibiotic per given diagnosis in pediatric ward of Kocani Hospital in 2016 year
ICD-10-CM code
Amp.
Ampicillin á 1.0 g
Amp.
Ceftriaxone á 1.0 g
Sir.
Cefalexine á 250 mg/5 ml
Caps.
Cefalexine á 500 mg
Sir.
Amoksicilline
+ clavulonic acid á
400 mg / 57 mg/5 ml
Sir.
Cefaclor á 250 mg/5 ml
Amp.
Cefotaxim á 500 mg
Amp.
Amikacin á 500 mg
Amp. Gentamicin
á
20 mg/2 ml
Amp. Gentamicin
á
40 mg/2 ml
1 J 00 Acute nasopharyngitis [common cold]
37
2 J 02 Acute pharyngitis
223 5 16
3 J 03.9 Acute tonsillitis, unspecified
416
16 7 8
4 J 04.0 Acute laryngitis
40
3
5 J 18.0 Bronchopneumonia,
unspecified organism 746
16
136
6 J 18.9 Pneumonia, unspecified organism
227
1 28 30
7 J 20.9 Acute bronchitis, unspecified
214
25
106
25
8 J 21.8 Acute bronchiolitis due to
other specified organisms 8
2
9 J 21.9 Acute bronchiolitis,
unspecified 74
10 J 40 Bronchitis, not specified as acute or chronic (asthma)
4
11 N 39.0 Acute cystitis
16
12 N 39.9 Disorder of urinary system,
unspecified 4
13 H 65.9 Unspecified
nonsuppurative otitis media 20
1 3
Total 0 2029 5 48 35 15 270 30 25 0
1 7
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Table 5. Usage of antibiotic per given diagnosis in pediatric ward of Kocani Hospital in 2017 year
ICD-10-CM code
Amp.
Ampicillin á 1.0 g
Amp.
Ceftriaxone á 1.0 g
Sir.
Cefalexine á 250 mg/5 ml
Caps.
Cefalexine á 500 mg
Sir.
Amoksicilline
+
clavulonic acid á
400 mg / 57 mg/5 ml
Sir.
Cefaclor á 250 mg/5 ml
Amp.
Cefotaxim á 500 mg
Amp.
Amikacin á 500 mg
Amp.
Gentamicin
á 20 mg/2 ml
Amp.
Gentamicin
á 40 mg/2 ml
1 J 00 Acute nasopharyngitis [common cold]
40
16
2 J 02 Acute pharyngitis 10 236
16
3 J 03.9 Acute tonsillitis, unspecified
17 45
10 10 9
4 J 04.0 Acute laryngitis
40
1
5 J 18.0 Bronchopneumonia,
unspecified organism 845
18
119 50
6 J 18.9 Pneumonia, unspecified
organism 148
9 36 14
7 J 20.9 Acute bronchitis,
unspecified 196
41
55
8 J 21.8 Acute bronchiolitis due to other specified organisms
5
4
9 J 21.9 Acute bronchiolitis,
unspecified 65
43
10 J 40 Bronchitis, not specified as
acute or chronic (asthma) 12 1
11 N 39.0 Acute cystitis
38
12
N 39.9 Disorder of urinary
system, unspecified 6
13 H 65.9 Unspecified nonsuppurative otitis media
24
4 11
Total 27 2113 1 60 59 30 210 64 0 43
1 8
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(2 ) 1
1 –
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(2 0 1
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Table 6. Usage of antibiotic per given diagnosis in pediatric ward of Kocani Hospital in 2018 year
ICD-10-CM code
Amp.
Ampicillin
á 1.0 g
Amp.
Ceftriaxone
á 1.0 g
Sir.
Cefalexine
á 250 mg/5
ml
Caps.
Cefalexine
á 500 mg
Sir.
Amoksicilline
+
clavulonic acid á
400 mg / 57 mg/5 ml
Sir.
Cefaclor
á 250 mg/5 ml
Amp.
Cefotaxim
á 500 mg
Amp.
Amikacin
á 500 mg
Amp.
Gentamicin
á 20 mg/2 ml
Amp.
Gentamicin
á 40 mg/2 ml
1 J 00 Acute nasopharyngitis [common cold]
304 50 32
50
2 J 02 Acute pharyngitis 428 260 32
260
3 J 03.9 Acute tonsillitis, unspecified 692 439 32 10 9
439
4 J 04.0 Acute laryngitis 220 40
2
40
5 J 18.0 Bronchopneumonia,
unspecified organism 883 96
124 80
883
6 J 18.9 Pneumonia, unspecified
organism 220
10 64 50
220
7 J 20.9 Acute bronchitis, unspecified
368
40
118
50
368
8 J 21.8 Acute bronchiolitis due to
other specified organisms 10
2
10
9 J 21.9 Acute bronchiolitis,
unspecified 178
80 178
10 J 40 Bronchitis, not specified as acute or chronic (asthma)
10
10
11 N 39.0 Acute cystitis
68
68
12 N 39.9 Disorder of urinary system, unspecified
12
12
13 H 65.9 Unspecified
nonsuppurative otitis media 28
1 4
28
Total 1644 2566 192 53 25 306 130 50 80 2566
Antibiotic consumption and management at Kocani General Hospital – Annual report
19
Макед. фарм. билт., 65 (2) 11 – 21 (2019)
doxycycline (children older than 8 years, 200 mg as single
dose in the first day, followed by 100 mg once a day
during the next days). These guidelines are in accordance
with recommendations published in Cochrane Database
Systematic Reviews by Lodha et al. (2013) where
amoxicillin as first-line therapy should be used, but with
additional possibility to use cefpodoximе and cefuroxime
as second-line therapies. Also, concomitant are
recommendations of World Health Organization (Tong,
2013; WHO, 2012) for very severe pneumonia where
parenteral ampicillin (or penicillin) and gentamicin are
recommended as a first line treatment, while ceftriaxone
should be used as a second line treatment when the first
line treatment fails.
Patients diagnosed with acute bronchitis (ICD-10-CM
code J20.9) were treated with Amp. Ceftriaxone á 1.0 g
in 57.84%, 67.12% and 63.89% of DDD of prescribed
antibiotics in 2016, 2017 and 2018 year, accordingly.
Amp. Cefotaxime á 5oo mg were used in 28.65%, 18.84%
and 20.49% of DDD of prescribed antibiotics in 2016,
2017 and 2018 year, accordingly. According to the
guidelines for medical care of light form of respiratory
pathways obstruction in children, issued by the Ministry
of healthcare of Republic of North Macedonia
(http://zdravstvo.gov.mk/wp-content/uploads/2015/08/
Tretman-na-opstruktiven-bronhitis-i-akutna-astma.pdf)
inhalation of salbutamol using metered-dose inhalers or
nebulizer is first choice for treatment. Medium severe
obstruction should be treated with repetitive application
of salbutamol with spacer or nebulizer with 100% oxygen
supplementation. Also, depending from symptoms
systematic corticosteroid might be considered. Similar are
recommendations for treatment of repetitive or prolonged
obstruction as well as severe obstruction. In the case of
severe obstruction additionally, use of anticholinergic
such as ipratropium bromide is suggested. Antibiotic use
is indicated in treatment of otitis, maxillary sinusitis and
pneumonia. These guidelines are in line with clinical data
that showed that antibiotics do not significantly change
the course of acute bronchitis, and might provide only
minimal benefit compared with the risk of antibiotic use
itself (Albert, 2010). However, studies showed that almost
2/3 of patients in United States with acute bronchitis are
treated with antibiotics with argument that they might
decrease the risk of subsequent pneumonia as well as
patient expectations for antibiotic prescription (Albert,
2010, Linder and Sim, 2002).
Conclusion
Results from conducted survey identified high
prescription rate and use of antibiotics predominantly
ceftriaxone, a third generation of cephalosporin, for
pediatric and infant patients admitted in Kocani Hospital
in the period 2016-2018. In the studied period decrease of
cephalosporin usage was observed especially in 2018 and
it was related to the increase of ampicillin use. The most
frequent diagnoses were acute tonsillitis, pneumonia
without complications and acute bronchitis. Treatment of
patients diagnosed with acute tonsillitis in 2016-2017 was
mostly based on ceftriaxone, while in 2018 ampicillin
prevailed. In the case of pneumonia without
complications ceftriaxone was also most commonly used
antibiotic although WHO recommends it as a second line
treatment when the first line treatment fails. When acute
bronchitis was in question, ceftriaxone and cefotaxime
were most used antibiotics contrary to official
recommendations and evidences based on clinical data.
So, it is foreseeable to conclude that there is urgent need
for restrictive and educational measures i.e. to strength
the surveillance and monitoring of antibiotic prescription
and usage and hence to promote awareness for rational
use of antibiotics on all health-care levels.
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Макед. фарм. билт., 65 (2) 11 – 21 (2019)
Резиме
Употреба и управување со антибиотици во Општа
болница Кочани – годишен извештај
Нада Илиева, Милена Николова, Донка Панков, Маја Симоноска Црцаревска,
Кристина Младеновска, Душко Шалабалија, Љубица Михаилова,
Олга Гигопулу, Марија Главаш Додов*
Фармацевтски факултет, Универзитет „Св. Кирил и Методиј”, Мајка Тереза 47,
1000 Скопје, Р. Северна Македонија
Клучни зборови: пропишување на антибиотици, употреба на антибиотици, педијатарски оддели, годишен
извештај
Целта на студијата беше да се добие детален увид во трендовите на потрошувачка на антибиотици во
тригодишниот период (2016-2018 година) во болницата во Кочани, да се идентификуваат најчесто пропишаните
антибиотици и да се утврди дали третманот на дадената дијагноза е во согласност со официјалните упатства.
Истражувањето ги опфати сите деца и новороденчиња примени на педијатриското одделение. Податоците на
пациентите вклучуваат: пол, возраст, дијагноза, користен антибиотик и дозирање. Поголемиот дел од примените
пациенти биле во возрасна група од 0-1 година (27,48%, 25,94% и 30,77% за 2016, 2017 и 2018 година, соодветно),
потоа следува возрасната група од 1-2 години (20,86%, 22,0% и 23,83% за 2016, 2017 и 2018 година,
последователно) и возрасната група 2-3 години (16,06%, 16,1% и 14,63% за 2016, 2017 и 2018 година,
последователно). Во периодот од 2016-2018 година најчеста дијагноза била акутен тонзилитис, утврден кај ~21%
од пациентите, потоа следува пневмонија без компликации, кај ~18% од пациентите и акутен бронхитис кај ~16%
од пациентите. Резултатите од спроведеното истражување покажаа висока стапка на пропишување и употреба на
антибиотици, претежно цефтриаксон (82,58%, 81,05% и 50,85% во 2016, 2017 и 2018 година, соодветно)
спротивно на официјалните препораки и докази засновани врз клиничките податоци за третман на соодветните
дијагнози. Добиените резултати од истражувањето укажуваат дека постои итна потреба од примена на
рестриктивни и едукативни мерки, т.е. да се зајакне надзорот и следењето на пропишувањето и употребата на
антибиотици и да се зголеми свесноста за рационална употреба на антибиотици на сите нивоа на здравствената
заштитa.
