Antimicrobial use in humans

Ann Versporten

Prof. Herman Goossens

OIE Global Conference on the Responsible and Prudent Use of Antimicrobial Agents for Animals

- 13 March 2013 -

Ann.versporten@ua.ac.be Herman.goossens@uza.be

“If you cannot measure it, you cannot improve it”

Lord Kelvin 1824-1907

Importent research questions What is the quantity and quality of antibiotic use

Geographical distribution and ranges

Outpatient – inpatient use

Adults – children

….

What are the determinants of inappropriate antibiotic

use?

Patient related (diagnosis, age, underlying disease, ….)

Prescriber related (training)

Institutional factors (national/local policy, availability of

drugs on market, existing guidelines, hospital type, ….)

Cultural factors, custums, ….

3

Collection of antibiotic use data

We need:

Valid, representative and comparable data

Interpretable units of measurement to express

volumes of antibiotic use

Longitudinal data to analyze trends over time

Evaluation methods to assess impact of

interventions aiming at optimizing antibiotic use

Common methodology

4

How measuring human antibiotic use

WHO ATC/DDD classification method = gold

standard measuring unit for international human drug utilization research:

o Anatomical Therapeutic Chemical (ATC)

classification system (5 levels up to substance level)

o Defined Daily Doses (DDD) = assumed average

maintenance dose per day for a drug used for its main indication in adults.

Drug specifications needed: unit strength &

pack size

http://www.whocc.no/

How measuring human antibiotic use

N packages

N days of therapy

N Defined Daily Doses

….. N prescribed daily doses

N persons

N

prescriptions

Nominators Denominators

All inpatients

All days of therapy

All full courses

Total population

All admissions

All prescribed

daily doses

All persons

All persons insured

All prescriptions

…

Interpretation of antibiotic use data Critical factors:

o Dosage (strength of active ingredient)

o Duration of therapy and time interval

o Clinical justification

o Targeted / empirical treatment

o Choice of drug (availability on market)

o Indication (community acquired – hospital

acquired infection)

o Guidelines

o Local resistance patterns

o ……

Total outpatient antibiotic use in 33 European countries in 2009 in DID (2004 data for

Switzerland).

Adriaenssens N et al. J. Antimicrob. Chemother.

2011;66:vi3-vi12

© The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial

Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Outpatient use of penicillins in 33 European countries in 2009 in DID (2004 data for

Switzerland).

Versporten A et al. J. Antimicrob. Chemother.

2011;66:vi13-vi23

© The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial

Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Assessing impact of interventions

•Prescrip-tions

•persons

•packages •DDD

DID PID

PrID PersonsID

Antibiotic consumption

Antibiotic resistance

Campaigns

Time

Belgian National Public Campaigns

• When: since November 2000, annually during winter

season

• Organised by BAPCOC (Belgian Antibiotic Policy

Coordination Committee)

• Budget: € 400,000 /annual campaign

• Interventions targeting the public & professionals:

o TV, radio and newspaper

o Information booklets

o Folders

o Posters

o Internet campaigns: www.antibiotics-info.be

0

0.5

1

1.5

2

2.5

3

3.5

4

97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10

Packages p

er

1000 inhabitants

per

day Other J01 classes

Sulfonamides and trimethoprim (J01E)

Quinolones (J01M)

Macrolides, lincosamides andstreptogramins (J01F)

Tetracyclines (J01A)

Cephalosporins and other beta-lactams (J01D)

Penicillins (J01C)

-1.0%-3.4%

-6.4%

-9.1%

-6.9%

-7.5%-4.0%

-7.3%

-3.5%

-0.3%

-37%

-0.8%+0,8%

Outpatient antibiotic use in Belgium 1997-2010 in

Packages per 1000 Inhabitants per Day

0

5

10

15

20

25

30

97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10

DD

D p

er

1000 inhabitants

per

day Other J01 classes

Sulfonamides and trimethoprim (J01E)

Quinolones (J01M)

Macrolides, lincosamides andstreptogramins (J01F)

Tetracyclines (J01A)

Cephalosporins and other beta-lactams (J01D)

Penicillins (J01C)

+2.6%-1.8%

-3.9%

-5.5% -0.9%+2.1% +1.5% -1.3%-0.6%

+2.7%

- 0.1%

-0.6%+5.3%

Outpatient antibiotic use in Belgium 1997-2010 in

DDD per 1000 Inhabitants per Day

Key message : obtain meaningful comparisons

Uniformity of data collection - Use similar study

designs, standardized protocol and data collection

templates

SIMPLE protocol = feasible & achievable surveillance

Quality assurance approach – implementation of

data validation process

Continuous work on data accuracy

Central support towards data collection or other

(helpdesk)

Mutual cooperation/feedback is highly motivating

“sustained awareness”

15

Conclusion • Implementation of a common methodology to

collect valid, representative and comparable antimicrobial consumption data

• Employ different outcome measurement units enabling an in-depth interpretation of antimicrobial consumption data

• Creation of reference database at national and international level

• Potential of scientific output

• Potential to link with antimicrobial resistance data

• Potential to link with other research projects

• Networking

• Sustainability

16

If you want to go Fast, go alone. If you want to go Far, go together.