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Application of the ATC/DDD methodology to monitor antibiotic drug use

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Abstract

In order to monitor the use of antibiotics, it is essential to have comprehensive data on drug consumption. The findings of drug utilisation studies can serve to describe the pattern of drug use in a particular population, to detect areas of concern, and to evaluate the impact of interventions taken to influence the use of drugs. In the present study, the Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) system developed by the World Health Organisation was evaluated. The system measures the amount of drug use independentof package size and sales price, which allows comparisons not only within an institution but also within a region, a country, or even internationally. Obviously, there can be no modifications of this system. To illustrate the method, the pattern of quinolone use in the general population, in long-term care facilities, and within a single institution was analysed. These drugs were widely used in long-term care facilities in the Nijmegen region of the Netherlands, accounting for about 30% of the antibiotics used in these settings, whereas in the general population as well as in the University Hospital Nijmegen, these drugs constitute only about 6% of the total antibiotics used. These differences are large enough to warrant closer analysis of patterns of antibiotic usage in different settings to identify the reasons for the use of quinolones and to identify measures that might be taken to rationalise the prescription of these drugs.

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References

  1. Neu HC: The crisis in antibiotic resistance. Science 1992, 257: 1064–1073.

    Google Scholar 

  2. Quinn JP: Clinical implications of antibiotic resistance. Pharmacotherapy 1992, 12: 391–396.

    Google Scholar 

  3. Murray BE: New aspects of antimicrobial resistance and the resulting therapeutic dilemmas. Journal of Infectious Diseases 1991, 163: 1184–1194.

    Google Scholar 

  4. Kunin CM: Resistance to antimicrobial drugs—a world-wide calamity. Annals of Internal Medicine 1993, 118: 557–561.

    Google Scholar 

  5. Carbon C: Antibiotic usage: policy, clinical and pharmacoeconomic outcomes. Drugs 1996, 52, Supplement 2: 78–79.

    Google Scholar 

  6. Guglielmo BJ, Brooks GF: Antimicrobial therapy. Costbenefit considerations. Drugs 1989, 38: 473–480.

    Google Scholar 

  7. Gyssens JC, Lennards CA, Hekster YA, van der Meer JW: Cost of hospital antimicrobial chemotherapy. A method for global cost calculation. Pharmaceutisch Weekblad Scientific Edition 1991, 13: 248–253.

    Google Scholar 

  8. Avorn J, Gross A, Armstrong R, Schulke D, Steiner JF, Strom BL, Werner WN: Panel III: intervention: The use of drug utilization review outcomes. Clinical Pharmacology and Therapeutics 1991, 50: 633–635.

    Google Scholar 

  9. Lee D, Bergman U: Studies of drug utilization. In: Strom BL (ed): Pharmacoepidemiology. Wiley Publishers, Chichester, 1994, p. 379–393.

    Google Scholar 

  10. Serradell J, Bjornson DC, Hartzema AG: Drug utilization study methodologies: national and international perspectives. Drug Intelligence and Clinical Pharmacology 1987, 21: 994–1001.

    Google Scholar 

  11. Himmelberg CJ, Pleasants RA, Weber DJ, Kessler JM, Samsa GP, Spivey JM, Morris TL: Use of antimicrobial drugs in adults before and after removal of a restriction policy. American Journal of Hospital Pharmacy 1991, 48: 1220–1227.

    Google Scholar 

  12. Gyssens JC, Kullberg BJ: Improving the quality of antimicrobial drug use can result in cost containment. Pharmacy World and Science 1995, 17: 163–167.

    Google Scholar 

  13. Thomas M, Govil S, Moses BV, Joseph A: Monitoring of antibiotic use in a primary and tertiary care hospital. Journal of Clinical Epidemiology 1996, 49: 251–254.

    Google Scholar 

  14. Cadle RMC, Darouiche RO, Tibbetts CS, Graviss E: Pharmacist's impact on antimicrobial drug therapy. American Journal of Health-System Pharmacists 1995, 52: 1544–1546.

    Google Scholar 

  15. Bryan CS: Strategies to improve antibiotic use. Infectious Disease Clinics of North America 1989, 3: 723–734.

    Google Scholar 

  16. World Health Organisation: Guidelines for ATC classification and DDD assignment. Norsk Medisinaldepot, Oslo, 1996.

    Google Scholar 

  17. Bergman U, Christenson I, Jansson B, Wilholm B-E: Auditing hospital drug utilisation by means of defined daily doses per bed-day; a methodological study. European Journal of Clinical Pharmacology 1980, 17: 183–187.

    Google Scholar 

  18. Wessling A, Boethius G: Measurement of drug use in a defined population; evaluation of the defined daily dose (DDD) methodology. European Journal of Clinical Pharmacology 1990, 39: 207–210.

    Google Scholar 

  19. Bergman U, Sjöqvist F: Measurement of drug utilization in Sweden: methodological and clinical implications. Acta Medica Scandinavica 1984, Supplement 683: 15–22.

    Google Scholar 

  20. Wertheimer AI: The defined daily dose system (DDD) for drug utilization review. Hospital Pharmacy 1986, 21: 233–258.

    Google Scholar 

  21. Frieden TR, Mangi RJ: Inappropriate use of oral ciprofioxacin. Journal of the American Medical Association 1990, 264: 1438–1440.

    Google Scholar 

  22. Intravenous ciprofloxacin: a position statement by the Society of Infectious Diseases Pharmacists. Annals of Pharmacotherapy 1993, 27: 362–364.

    Google Scholar 

  23. Wolfson JS, Hooper DC: Bacterial resistance to quinolones: mechanisms and clinical importance. Reviews of Infectious Diseases 1989, 11, Supplement 5: 960–968.

    Google Scholar 

  24. Neu HC: Bacterial resistance to fluoroquinolones. Reviews of Infectious Diseases 1988, 10, Supplement 1: 57–63.

    Google Scholar 

  25. Trucksis M, Hooper DC, Wolfson JS: Emerging resistance to fluoroquinolones in staphylococci: an alert. Annals of Internal Medicine 1991, 114: 424–426.

    Google Scholar 

  26. Pena C, Albareda JM, Pallares R, Pujol M, Tubau F, Ariza J: Relationship between quinolone use and emergence of ciprofloxacin-resistantEscherichia coli in bloodstream infections. Antimicrobial Agents and Chemotherapy 1995, 39: 520–524.

    Google Scholar 

  27. Coronado V, Edwards JR, Culver DH, Gaynes RP: Ciprofloxacin resistance among nosocomialPseudomonas aeruginosa andStaphylococcus aureus in the United States. Infection Control and Hospital Epidemiology 1995, 16: 71–75.

    Google Scholar 

  28. Herings RMC, de Boer A, Stricker BHCh, Leufkens HGM, Porsius A: Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme. Lancet 1995, 345: 1195–1198.

    Google Scholar 

  29. Pathor M, Chrischilles EA, Guralnik JM, Brown SL, Wallace RB, Carbonin P: Drug data coding and analysis in epidemiologic studies. European Journal of Epidemiology 1994, 10: 405–411.

    Google Scholar 

  30. Heinzl S: DDD-geeignetes Maß für Therapiekosten? Medizinische Monatsschrift für Pharmazeuten 1992, 15: 193.

    Google Scholar 

  31. Bjornsson TD: A classification of drug action based on therapeutic effects. Journal of Clinical Pharmacology 1996, 36: 669–673.

    Google Scholar 

  32. Gyssens IC, Geerligs IEJ, Dony JMJ, van der Vliet JA, van Kampen A, van den Broek PJ, Hekster YA, van der Meer JWM: Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. Journal of Antimicrobial Chemotherapy 1996, 38: 1001–1012.

    Google Scholar 

  33. Dekker AW, Verdonck LF, Rozenberg-Arska M: Infection prevention in autologous bone marrow transplantation and the role of protective isolation. Bone Marrow Transplantation 1994, 14: 89–93.

    Google Scholar 

  34. Guglielmo BJ: Practical strategies for the appropriate use of antimicrobials. Pharmacy World and Science 1995, 17: 96–102.

    Google Scholar 

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Natsch, S., Hekster, Y.A., de Jong, R. et al. Application of the ATC/DDD methodology to monitor antibiotic drug use. Eur. J. Clin. Microbiol. Infect. Dis. 17, 20–24 (1998). https://doi.org/10.1007/BF01584358

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