RESEARCH – November 2020

Outpatient antibiotic use in Estonia

Authors: Jana Lass, Piret Mitt, Kaidi Telling, Elviira Linask, Ott Laius, Epp Sepp, Paul Naaber, Irja Lutsar

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Background and objectives: The current study describes changes in the pattern of prescribing outpatient antibacterial medicines in Estonia during 2008-2018, compares antibiotic use and changes in the patterns of antimicrobial resistance in Estonia and in the Nordic countries.

Methods: Data of antibiotic use is presente as defined daily doses per 1000 inhabitants per day (DDD/1000/day) and is based on the wholesaler’s quarterly reports. The quality of antibiotic use is assessed using the ESACNet (European Surveillance of Antimicrobial Consumption) quality indicators. Microbial resistance data is based on the ECDC (European Centre for Diseases Prevention and Control) data.

Results: The consumption of outpatient antibiotics in Estonia in 2018 was similar to the consumption in Finland, Sweden, Denmark and Norway (10.2; 13.2; 10.8; 13.7 and 14.0 DDD/1000/day, respectively). Although there were no marked changes in the total consumption of antibacterial medicines in Estonia during 2008-2018, the spectrum of prescribed antibacterial medicines changed. The number of prescriptions for broad-spectrum penicillins decreased and the number of prescriptions for penicillin and betalactamase inhibiitor combination products increased. Cephalosporin use increased slightly in the study period and the consumption of quinolone antibiotics decreased. According to the ESAC-Net quality indicators for outpatient antibacterial medicines, their use was relatively similar to that of the Scandinavian countries, except for the proportion of belatactamase-sensitive penicillins, which was higher in the Nordic countries compared to Estonia.

Conclusion: The total use of antibacterial medicines in Estonia is stable but lower compared to the European countries. However, the use of broad-spectrum antibiotics is increasing in Estonia, which requires further analysis.