Odnos vanbolničke upotrebe antibakterijskih lekova i prevalencije bakterijskih infekcija u Crnoj Gori

Majda M Šahman-Zaimović; Saša Vukmirović; Nataša Tomić; Nebojša Stilinović; Olga Horvat; Ljiljana Tomić

doi:10.2298/VSP150626146S

Majda M Šahman-Zaimović
Saša Vukmirović Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Nataša Tomić Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia
Nebojša Stilinović Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Olga Horvat Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Ljiljana Tomić University of Bjeljina, Bjeljina, Republic of Srpska, Bosnia and Herzegovina

DOI: https://doi.org/10.2298/VSP150626146S

Ključne reči: bacterial infection||, ||infekcija, bakterijska, anti-bacterial agents||, ||antibiotici, outpatients||, ||bolesnici, vanbolničko lečenje, prevalence||, ||prevalencija, montenegro||, ||crna gora,

Sažetak

Uvod/Cilj. Prekomerna upotreba antibiotika izlaže bolesnike riziku od pojave neželjenih dejstava, uzrokuje ponovne posete lekaru i dovodi do pojave rezistencije bakterija na antibiotike. Upotreba antibiotika u Crnoj Gori u 2011. godini bila je visoka [39,05 definisanih dnevnih doza (DDD)/1 000 stanovnika/dan)], ali nije razmatrana u odnosu na učestalost vanbolničkih bakterijakih infekcija. Cilj ovog rada bio je da se ispita usklađenost upotrebe antibiotika i učestalosti vanbolničkih bakterijskih infekcija u Crnoj Gori. Metode. Podaci o upotrebi antibiotika dobijeni su od Agencije za lekove i medicinska sredstva Crne Gore. Upotreba je izračunata pomoću Anatomic Therapeutic Chemical (ATC)/DDD metodologije. Podaci o učestalosti vanbolničkih bakterijskih infekcija dobijeni su iz Zdravstvenog statističkog godišnjaka Crne Gore, a učestalost je izražena brojem slučajeva na 1 000 stanovnika. Rezultati. Vanbolnička upotreba antibiotika u Crnoj gori u 2012. godini iznosila je 30,34 DDD/1000 stanovnika/dan, a najčešće korišćeni bili su penicilini. Amoksicilin sam i u kombinaciji sa klavulanskom kiselinom bili su najčešće korišćeni antibiotici. Bakterijske infekcije bile su registrovane kod 6 745 bolesnika, odnosno kod 10,87 bolesnika/1 000 stanovnika. Najčešće zabeležene bile su respiratorne infekcije. Manje od 50% od upotrebljene količine antibiotika korišćeno je u skladu sa nacionalnim preporukama za lečenje bakterijskih infekcija. Zaključak. Vanbolnička upotreba antibiotika u Crnoj Gori u 2012. godini bila je više nego dvostruko veća od potrebne, ukoliko se u obzir uzme učestalost vanbolničkih bakterijskih infekcija i prosečna dužina lečenja. Struktura upotrebljenih antibiotika nije bila u potpunosti u skladu sa nacionalnim preporukama dobre kliničke prakse, ali je bila u skladu sa podacima o bakterijskoj rezistanciji u vanbolničkim uslovima. Potrebno je sprovesti mere sa ciljem racionalizacije upotrebe antibiotika u Crnoj Gori, kako u pogledu količine, tako i u pogledu izbora najčešće korišćenih antibiotika.

Biografija autora

Majda M Šahman-Zaimović

zamjenik direktora Agencije

Reference

Sabo A, JakovljevicV, Jocic LJ. Extremely high prescribing of an-timicrobials in the district of Novi Sad. Jugoslav Physiol Pharmacol Acta 1982; Suppl 2: s208−9. (Serbian)

Horvat O. Outhospital use of antibacterial drugs and antimi-crobial resistance of bacteria in South Backa District [disserta-tion]. Novi Sad: Faculty of Medicine, University of Novi Sad; 2010. (Serbian)

Kuyvenhoven MM, Balen FA, Verheij TJ. Outpatient antibiotic prescriptions from 1992 to 2001 in the Netherlands. J Antimi-crob Chemother 2003; 52(4): 675−8.

Goossens H, Ferech M, Vander SR, Elseviers M. Outpatient antibi-otic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365(9459): 579−87.

Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: A randomised, double-blind, placebo-controlled study. Lancet 2007; 369(9560): 482−90.

Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, et al. Antibiotic use in eastern Europe: A cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis 2014; 14(5): 381−7.

WHO Collaborating Centre for Drug Statistics Methodology. Guide-lines for ATC classification and DDD assignment, 2012. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health; 2011.

Institute Of Public Health. Health Statistical Yearbook 2012 of Montenegro. Podgorica: Institute Of Public Health; 2014.

Buke C, Hosgor-Limoncu M, Ermertcan S, Ciceklioglu M, Tuncel M, Köse T, et al. Irrational use of antibiotics among university stu-dents. J Infect 2005; 51(2): 135−9.

Sahman Zaimovic M. Relationship pharmacotherapeutic practices and outpatient resistance in bacterial infections [dissertation]. Novi Sad,: Faculty of Medicine, University of Novi Sad; 2012. (Serbian)

Veličković-Radovanović R, Petrović J, Kocić B, Antić S, Randelović G. Correlation between antibiotic consumption and bacterial re-sistance as quality indicator of proper use of these drugs in in-patients. Vojnosanit Pregl 2009; 66(4): 307−12.

European Centre for Disease Prevention and Control. Surveillance of antimicrobial consumption in Europe, 2010. Stockholm: ECDC; 2013.

European Centre for Disease Prevention and Control. Surveillance of antimicrobial consumption in Europe 2011. Stockholm: ECDC; 2014.

Centre for Disease Prevention and Control. Surveillance of an-timicrobial consumption in Europe 2012. Stockholm: ECDC; 2014.

Nikolić G. Rational use of antibiotics in primary health care. Podgorica: Ministry of Helath of Montenegro; 2012.

Stanulovic M, Banic B, Jakovljevic V, Nicin S, Djakovic SK. The uti-lization of drugs in Novi Sad: Determination of some im-portant characteristics. Pharmaca 1979; 17: 344−55. (Serbian)

Veličković-Radovanović R, Kodela B, Petrović J, Mitić R, Rančić M. Outpatient Antibiotic Use In Primary Healthcare Of Niš Re-gion. Sci J Faculty Med Niš 2010; 27(1): 27−32.

Vukmirovic S. Pharmacoepidemiological and pharmacotherapeutic aspects of antibacterial use-adherence to National guidelines and local resistance patterns [dissertation]. Novi Sad: Faculty of Medicine, University of Novi Sad; 2013. (Serbian).

Stimac D. Trend and quality of outpatient antibiotic utilization in Croatia from 2008-2012. 6th European Public Health Con-ference; Brussels; 2013 November 16. Eur J Public Health 2013; 23(Suppl 1): 205.

Skliros E, Merkouris P, Papazafiropoulou A, Gikas A, Matzouranis G, Papafragos C, et al. Self-medication with antibiotics in rural population in Greece: a cross-sectional multicenter study. BMC Fam Pract 2010; 11(1): 58.

Ministry of Health Montenegro. National Strategy for the Control of. Bacterial Resistance to Antibiotics 2012-2016. Podgorica: Ministry of Health Montenegro; 2012. (Serbian)

Ministry of Health Montenegro. National plan for rational use of drugs in Montenegro 2012-2016. Podgorica; Ministry of Health Montenegro; 2012. (Serbian)