Prevalence of Antibiotic Prescription in Primary Healthcare Settings in the Municipality of Prishtina, Kosovo

ORIGINAL ARTICLE
Valon Krasniqi, Elton Bahtiri, Flaka Pasha, Vjollca Zeqiri, Sami Uka, Peter Zarb, Lul Raka, Hasime Qorraj Bytyqi, Blana Krasniqi

 
For citation: Krasniqi V, Bahtiri E, Pasha F, Zeqiri V, Uka S, Zarb P, Raka L, Bytyqi HQ, Krasniqi B. Prevalence of Antibiotic Prescription in Primary Healthcare Settings in the Municipality of Prishtina, Kosovo. International Journal of Biomedicine. 2024;14(1):134-140. doi:10.21103/Article14(1)_OA21
 
Originally published March 1, 2024

Abstract: 

Background: Antibiotics remain among the most prescribed drugs in primary healthcare, contributing to increased antibiotic resistance in the community and prevailing as an emerging global health concern. We aimed to quantify the prevalence and quality of antibiotic prescription in primary healthcare settings in the Municipality of Prishtina to identify targets for quality improvement.
Methods and Results: This study represents a population-based, retrospective cohort, including data from eight randomly selected family medical centers in the Municipality of Prishtina. Each 150th patient on medical records was assessed for demographic data, diagnosis (ICD-10), antibiotic prescription, antibiotic class, and antibiotic form. In total, the study included 1614 cases reviewed. The antibiotic prescription rate was 16%. The health condition for which most of the cases received antibiotics was J18 - Pneumonia, unspecified organism (67%), followed by J03 - Acute tonsillitis (54%), J42 - Unspecified chronic bronchitis (46%), and N39 - Other disorders of the urinary system (43%) Broad-spectrum antibiotics, such as co-amoxiclav (17.7%), amoxicillin (16.5%), and ceftriaxone (12.6%), featured among the most routinely prescribed antibiotics. The antibiotic prescription rate was the highest for cases in the 3-5 age group, of whom 27% received an antibiotic prescription. In 73% of cases, oral antibiotics were prescribed, 69% of which belong to the WHO AWaRe (Access, Watch, Reserve) essential medicines list. Only 18% of antibiotics were prescribed with their generic names.
Conclusion: The prevalence of antibiotic prescription in primary healthcare settings in Prishtina is moderately low. These data cannot be extrapolated to other municipalities in Kosovo or other countries due to different organizational levels. High antibiotic prescription rates for young age groups, prescription of broad-spectrum antibiotics, and high rates of parenteral antibiotics were identified as targets for quality improvement.

Keywords: 
antibiotic prescription • primary healthcare • antibiotic resistance • Kosovo
References: 
  1. The World Bank. Life expectancy at birth, total (years). Available from: https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=XK&view=chart.
  2. Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015 Dec;15(12):1429-37. doi: 10.1016/S1473-3099(15)00270-4. Epub 2015 Oct 22. PMID: 26482597.
  3. Fleming DM, Ross AM, Cross KW, Kendall H. The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing. Br J Gen Pract. 2003 Oct;53(495):778-83. PMID: 14601353; PMCID: PMC1314710.
  4. Llor C, Hernández S. Enfermedad infecciosa en atención primaria: estudio prospectivo efectuado durante todo un año [Infectious disease in primary care: 1-year prospective study]. Enferm Infecc Microbiol Clin. 2010 Apr;28(4):222-6. Spanish. doi: 10.1016/j.eimc.2009.03.014. Epub 2009 Aug 31. PMID: 19720435.
  5. Kristiansson C, Reilly M, Gotuzzo E, Rodriguez H, Bartoloni A, Thorson A, Falkenberg T, Bartalesi F, Tomson G, Larsson M. Antibiotic use and health-seeking behaviour in an underprivileged area of Perú. Trop Med Int Health. 2008 Mar;13(3):434-41. doi: 10.1111/j.1365-3156.2008.02019.x. PMID: 18397405.
  6. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096. PMID: 20483949.
  7. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015 Apr;40(4):277-83. PMID: 25859123; PMCID: PMC4378521.
  8. McCullough AR, Rathbone J, Parekh S, Hoffmann TC, Del Mar CB. Not in my backyard: a systematic review of clinicians' knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother. 2015 Sep;70(9):2465-73. doi: 10.1093/jac/dkv164. Epub 2015 Jun 20. PMID: 26093375.
  9. Cadieux G, Tamblyn R, Dauphinee D, Libman M. Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ. 2007 Oct 9;177(8):877-83. doi: 10.1503/cmaj.070151. PMID: 17923655; PMCID: PMC1995156.
  10. Curtis HJ, Walker AJ, Mahtani KR, Goldacre B. Time trends and geographical variation in prescribing of antibiotics in England 1998-2017. J Antimicrob Chemother. 2019 Jan 1;74(1):242-250. doi: 10.1093/jac/dky377. PMID: 30239809.
  11. Bätzing-Feigenbaum J, Schulz M, Schulz M, Hering R, Kern WV. Outpatient Antibiotic Prescription. Dtsch Arztebl Int. 2016 Jul 1;113(26):454-9. doi: 10.3238/arztebl.2016.0454. PMID: 27412990; PMCID: PMC4946328.
  12. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, Nisar MA, Alvi RF, Aslam MA, Qamar MU, Salamat MKF, Baloch Z. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018 Oct 10;11:1645-1658. doi: 10.2147/IDR.S173867. PMID: 30349322; PMCID: PMC6188119.
  13. Ministry of Health, Republic of Kosovo (2018) PLANI STRATEGJIK PËR REZISTENCËN ANTIMIKROBIKE 2019-2021. Available: http://konsultimet.rks-gov.net/viewConsult.php?ConsultationID=40484.
  14. Davari M, Khorasani E, Tigabu BM. Factors Influencing Prescribing Decisions of Physicians: A Review. Ethiop J Health Sci. 2018 Nov;28(6):795-804. doi: 10.4314/ejhs.v28i6.15. PMID: 30607097; PMCID: PMC6308758.
  15. Mustafa M, Hysa B. Kosovo healthcare system still without consolidated funding! Alban Med J. 2016;1:45-51.
  16. Ymerhalili G, Maxhuni B. Integrating Care in Kosovo: challenges for Primary Health Care. International Journal of Integrated Care.2017;17(5):A265.
  17. Accessible Quality Healthcare (2018). Primary Health Care in Kosovo. Quality of Care Study. Available: http://www.aqhproject.org/wp-content/uploads/2019/03/AQH-QoC-Prishtin%C3%AB-WEB-4.pdf.
  18. Hoxha T. Yearly report of medical visits and services in Main Family Medical Centre of Prishtina (2017). Available: http://www.qkmf-pr.org/prezentimet-dhe-raportet.
  19. Butler CC, Dunstan F, Heginbothom M, Mason B, Roberts Z, Hillier S, Howe R, Palmer S, Howard A. Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices. Br J Gen Pract. 2007 Oct;57(543):785-92. PMID: 17925135; PMCID: PMC2151810.
  20. Hamers RL, van Doorn HR. Antibiotic consumption in low-income and middle-income countries. Lancet Glob Health. 2018 Jul;6(7):e732. doi: 10.1016/S2214-109X(18)30270-5. Erratum in: Lancet Glob Health. 2018 Sep;6(9):e967. PMID: 29903375.
  21. Ebben RH, Vloet LC, Verhofstad MH, Meijer S, Mintjes-de Groot JA, van Achterberg T. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review. Scand J Trauma Resusc Emerg Med. 2013 Feb 19;21:9. doi: 10.1186/1757-7241-21-9. PMID: 23422062; PMCID: PMC3599067.
  22. Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09. J Antimicrob Chemother. 2014 Jan;69(1):234-40. doi: 10.1093/jac/dkt301. Epub 2013 Jul 25. PMID: 23887867.
  23. Uijen JH, Bindels PJ, Schellevis FG, van der Wouden JC. ENT problems in Dutch children: trends in incidence rates, antibiotic prescribing and referrals 2002-2008. Scand J Prim Health Care. 2011 Jun;29(2):75-9. doi: 10.3109/02813432.2011.569140. PMID: 21591837; PMCID: PMC3347949.
  24. Holstiege J, Garbe E. Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr. 2013 Jun;172(6):787-95. doi: 10.1007/s00431-013-1958-y. Epub 2013 Feb 10. PMID: 23397325.
  25. Miller SA, Wu RKS, Oremus M. The association between antibiotic use in infancy and childhood overweight or obesity: a systematic review and meta-analysis. Obes Rev. 2018 Nov;19(11):1463-1475. doi: 10.1111/obr.12717. Epub 2018 Jul 23. PMID: 30035851.
  26. Randel A; Infectious Disease Society of America. IDSA Updates Guideline for Managing Group A Streptococcal Pharyngitis. Am Fam Physician. 2013 Sep 1;88(5):338-40. PMID: 24010402.
  27. Roque F, Herdeiro MT, Soares S, Teixeira Rodrigues A, Breitenfeld L, Figueiras A. Educational interventions to improve prescription and dispensing of antibiotics: a systematic review. BMC Public Health. 2014 Dec 15;14:1276. doi: 10.1186/1471-2458-14-1276. PMID: 25511932; PMCID: PMC4302109.
  28. Palumbi SR. Humans as the world's greatest evolutionary force. Science. 2001 Sep 7;293(5536):1786-90. doi: 10.1126/science.293.5536.1786. PMID: 11546863.
  29. Souliotis K, Papageorgiou M, Politi A, Athanasiadis A. Pharmaceutical Pricing Policy in Greece: Toward a Different Path. Front Public Health. 2016 Aug 31;4:185. doi: 10.3389/fpubh.2016.00185. PMID: 27630983; PMCID: PMC5005395.
  30. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18. doi: 10.1179/2047773215Y.0000000030. Epub 2015 Sep 7. PMID: 26343252; PMCID: PMC4768623.
  31. CDC: 1 in 3 antibiotic prescriptions unnecessary. (2016) Available from: https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html
  32. European Centre for Disease Prevention and Control. Strategies and action plans on antimicrobial resistance. Available from: http://www.euro.who.int/__data/assets/pdf_file/0010/378361/68wd08e_I_PR_AMR_180421.pdf?ua=1
  33. Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, Korinteli I, Raka L, Kambaralieva B, Cizmovic L, Carp A, Radonjic V, Maqsudova N, Celik HD, Payerl-Pal M, Pedersen HB, Sautenkova N, Goossens H; WHO/Europe-ESAC Project Group. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis. 2014 May;14(5):381-7. doi: 10.1016/S1473-3099(14)70071-4. Epub 2014 Mar 20. PMID: 24657114.
  34. World Health Organization. WHO Report on Surveillance of Antibiotic Consumption: 2016–2018 early implementation. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://eody.gov.gr/wp-content/uploads/2019/01/who_amr_amc_report_201811...
  35. Krasniqi S, Versporten A, Jakupi A, Raka D, Daci A, Krasniqi V, Deva Z, Rashiti A, Brajshori N, Hajdari S, Bytyqi J, Neziri B, Goossens H, Raka L. Antibiotic utilisation in adult and children patients in Kosovo hospitals. Eur J Hosp Pharm. 2019 May;26(3):146-151. doi: 10.1136/ejhpharm-2017-001363. Epub 2017 Oct 25. PMID: 31428322; PMCID: PMC6684012.
  36. Raka L, Kurti A, Jakupi A, Krasniqi S, Turjaka A. Kosovo's national action plan for antimicrobial resistance. Lancet Infect Dis. 2019 Mar;19(3):244. doi: 10.1016/S1473-3099(19)30052-0. PMID: 30833061.
  37. Sabuncu E, David J, Bernède-Bauduin C, Pépin S, Leroy M, Boëlle PY, Watier L, Guillemot D. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Med. 2009 Jun 2;6(6):e1000084. doi: 10.1371/journal.pmed.1000084. Epub 2009 Jun 2. PMID: 19492093; PMCID: PMC2683932.
  38. van Esch TEM, Brabers AEM, Hek K, van Dijk L, Verheij RA, de Jong JD. Does shared decision-making reduce antibiotic prescribing in primary care? J Antimicrob Chemother. 2018 Nov 1;73(11):3199-3205. doi: 10.1093/jac/dky321. PMID: 30165644.
  39. Broom J, Broom A, Good P, Lwin Z. Why is optimisation of antimicrobial use difficult at the end of life? Intern Med J. 2019 Feb;49(2):269-271. doi: 10.1111/imj.14200. PMID: 30754080.

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Received December 13, 2023.
Accepted January 27, 2024.
©2024 International Medical Research and Development Corporation.