Antimicrobial prescribing, community, surveillance, antimicrobial consumption
Introduction:
The current surveillance of outpatient antibiotic use in Ireland is collated by the HPSC using purchased Irish antibiotic sales data from IMS Health, which is unsuitable according to recommendations made by the Antibiotic Consumption Surveillance Working Group for SARI in 2003. This study aims to demonstrate the benefits of an antimicrobial consumption surveillance system in the community.
Methods:
Repeated, cross- sectional study comparing quantitative, point-prevalent antimicrobial prescription data across two years using a novel antimicrobial consumption surveillance form within four community pharmacies in one geographical region of a low prescribing county (16-21 DID). The GP consultation rate for Influenza-like Illness was identical for both the study periods.
Results:
Anonymous data for 257 prescriptions were recorded in week 12, 2010; and 248 for week 13, 2011. Only 4-5% of antimicrobials were prescribed by Dentists in the community. Public GMS patient antimicrobial usage was high, representing 33% of the Irish population, but resulting in 64% of prescriptions in 2010 and 55% in 2011. In 2010, 53% of prescriptions dispensed were for Penicillins, which was similar to the national level of 52%, however local levels were lower in 2011 at 44.7% compared to 54%. Narrow-spectrum penicillin use was half the national level for both years, favouring higher levels of Broad-spectrum penicillins of 19% in 2010 and 17.7% in 2011, compared to 15.9% and 15.7% nationally. Less Macrolides and Tetracyclines were observed locally with higher usage of Sulfonamides/Trimethoprim and ‘other antibiotic’ ATC classes. Local Cephalosporin use was over double the national level at 15% in 2010 and 14.5% in 2011, compared to 6% and 5.3% respectively. For every 12.4 prescriptions dispensed in the community, 1 was for a narrow-spectrum antibiotic in 2010, which decreased to 1 in every 15.2 in 2011.
Conclusions:
This study demonstrates its objective to highlight the benefits of an antimicrobial consumption surveillance system in the community. With deviations from national levels locally, areas needing intervention can be detected and local prescribers can be informed by providing feed-back on trends observed. This study shows that the pharmacy can act as the surveillance setting, expanding their role within the primary care team.