Evaluation of accordance of antibiotics package size with recommended treatment duration of guidelines for sore throat and urinary tract infections

Abstract

Background: The aim of this study was to investigate whether marketed antibiotics package sizes are in accordance with treatment durations recommended in guidelines for prescribing antibiotics in sore throat and urinary tract infections.

Methods: National drug database was searched with limitation to Antibacterials for systemic use. Formulations which did not have pre-specified dosage unit by the manufacturer were excluded (e.g. powders for oral solutions). The final list contained 94 drugs with 23 different active substances. This list was then cross-referenced with selected antimicrobial prescribing guidelines provided by Intersectoral Society for Antibiotic Resistance Control (ISKRA), National Institute for Health and Care Excellence (NICE) and The Infectious Diseases Society of America (IDSA).

Results: Seven packages matched ISKRA guidelines on sore throat while 16 were mismatched. Considering drug packages under reimbursement, 3 matched ISKRA guidelines and 8 were mismatched. Only 3 packages matched IDSA guidelines for comparable indications, and 18 were mismatched. When considering NICE guidelines there were 5 mismatched and only one package that was in accordance with the guidelines. ISKRA guidelines for urinary tract infections matched 23 packages and mismatched 58 packages. IDSA guidelines for urinary tract infections matched one package and were mismatched in 15 cases.

Conclusions: One of the causes of leftover antibiotics is poor accordance of antibiotic package size with treatment recommendation duration. This should be identified as a potential target for reduction of excess antibiotics in the community. Measures that promote patient adherence to therapy and patient education should be considered essential to manage proper handling of leftover antibiotics.

Keywords: Antibiotic resistance; Prescribing guideline; Sore throat; Urinary tract infections.

Fig. 1

Flowchart of identifying drugs eligible for inclusion in the study. ^aCroatian Agency for Medicinal Products and Medical Devices. ^bThe Intersectoral Society for Antibiotic Resistance Control. ^cNational Institute for Health and Care Excellence. ^dInfectious Diseases Society of America. ^eAvailable at: http://www.hzzo.hr/zdravstveni-sustav-rh/trazilica-za-lijekove-s-vazecih-lista/, last accessed: 16th August 2018

Fig. 2

Number of drug packages that would in case of accordance with the regimen proposed by the selected guidelines result in 0 excess units (matched). ^aThe Intersectoral Society for Antibiotic Resistance Control guidelines on sore throat: diagnostic and therapeutic approach and guidelines on antimicrobial treatment and prophylaxis of urinary tract infections. ^bClinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America and International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. ^cNational Institute for Health and Care Excellence Sore throat (acute): antimicrobial prescribing. ^dThe Intersectoral Society for Antibiotic Resistance Control (ISKRA) guidelines on antimicrobial treatment and prophylaxis of urinary tract infections. ^eInternational Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. ^fincluded in Croatian national reimbursement lists on 1^st of August 2018