Antibiotic Prescription Pattern of Family Physicians Across Turkey: A Cross-Sectional Analysis Through The Prescription Information System Abstract

Objectives: Ensuring the rational drug use has become one of the primary targets of health policies of countries. The drug use, which may be affected by many factors, should be regularly followed up by using scientific methods. In this context, determining the prescribing practices of physicians is the first step to define the measures to be taken against irrational drug use. In this study, we aimed to determine the rational use of antibiotics by family physicians in all provinces of Turkey for evaluation of current antibiotic pattern of family physicians across the country and between provinces. Methods: This was a retrospective descriptive study in which e-prescription data of family physicians during 2017 were obtained through the Prescription Information System (PIS). The number and percentage of prescriptions including antibiotics were determined, and the mostly preferred antibiotics in terms of number of items/boxes/costs were listed. Ten most commonly prescribed antibiotics were given for Turkey and its provinces. Results: In 2017, 22,778 family physicians entered at least one protocol (procedure) into the database through PIS across Turkey. The total number of protocols entered was 282,044,546 of which 50.21% (141,625,433) was prescription protocols. Of all the prescriptions written by family physicians in Turkey, 24.97% includes at least one antibiotic. When provinces were compared according to antibiotic prescription rates, Mardin was the first with 38.09% (357,950/939,856) followed by 35.72% (637,640/1,785,088) in Sanliurfa and 35.23% (2,109,931/5,988,772) in Adana. The three provinces with the lowest antibiotic prescription rates were Edirne (16.05%; 169,955/1,058,960), Yozgat (16.25%; 100,216/616,531) and Artvin (16.37%; 40,358/246,497). Antibiotics constituted 7.43% (n=29.284.158) of all of the drugs items in prescriptions, and total antibiotic cost is 3.45% (554.866.690 TL) of the total drug cost. Based on the number of items in the prescriptions, the most commonly prescribed antibiotics were amoxicillin and enzyme inhibitor, clarithromycin, and cefuroxime. Conclusion: This is the most comprehensive study examining the prescriptions of all family physicians for a year across Turkey. The results of the study showed that one fourth of prescriptions written by family physicians contain antibiotics. This rate is even higher in the south and southeastern regions. Mostly, broad-spectrum antibiotics are prescribed. Further research and training activities are needed to achieve the objectives of rational drug use for antibiotic prescribing in Turkey. Giris: Akilci ilac kullanimi, ulkelerin saglik politikalarinin oncelikli hedeflerinden birisi haline gelmistir. Pek cok faktorden etkilenebilen ilac kullanimi surecinin, bilimsel arastirmalarla duzenli olarak takip edilmesi gerekir. Bu kapsamda hekimlerin yazdiklari recetelerde kullandiklari ilaclarin izlenmesi, akilci olmayan ilac kullanimina karsi alinacak tedbirlerin belirlenmesi icin gereklidir. Bu arastirmada, Turkiye’nin tum illerindeki aile hekimlerince yazilmis olan recetelerdeki antibiyotik icerikleri degerlendirilerek mevcut akilci antibiyotik kullanim profilinin, ulke geneli ve illere gore dagiliminin belirlenmesi amaclanmistir.Yontem: Bu retrospektif tanimlayici calismada, Turkiye’deki aile hekimlerinin 2017 yili boyunca yazdiklari recete verileri, Recete Bilgi Sistemi (RBS) uzerinden incelenmistir. Tum receteler arasindan antibiyotik yazilanlar bulunarak, kalem/kutu/maliyet acisindan en sik recetelenen antibiyotikler tespit edilmistir. En sik recetelenen 10 antibiyotigin dagilimi, Turkiye geneli icin ve illere gore sunulmustur. Bulgular: 2017 yili boyunca Turkiye genelinde protokol ureten (islem yapan) aile hekimi sayisi 22.778’dir. Aile hekimleri tarafindan veri tabanina girilen 282.044.546 toplam protokolun %50,21’inde (n=141.625.433) recete olusturulmustur. Turkiye genelinde aile hekimleri tarafindan yazilan recetelerin %24,97’si (35.364.710 recete) ilac olarak en az bir antibiyotik icermektedir. Antibiyotik bulunan recete yuzdelerine gore iller karsilastirildiginda, %38,09 oraniyla (357.950/939.856) Mardin’in ilk sirada yer aldigi, Şanliurfa’nin %35,72 (637.640/1.785.088) ve Adana’nin %35,23 (2.109.931/5.988/772) oranlariyla takip ettigi gorulmustur. En dusuk antibiyotik iceren recete yuzdesine sahip uc il ise Edirne (%16,05; 169.955/1.058.960), Yozgat (%16,25; 100.216/616.531) ve Artvin’dir (%16,37; 40.358/246.497). Recetelerdeki toplam antibiyotik kalem sayisi, tum ilac kalem sayisinin %7,41’i (n=29.284.158), toplam antibiyotik maliyeti ise tum ilac maliyetinin %3,45’idir (554.866.690 TL). Kalem sayisina gore en sik recetelenen antibiyotikler, amoksisilin ve beta-laktamaz inhibitoru kombinasyonu, klaritromisin ve sefuroksim aksetil olmustur. Sonuc: Sunulan calisma, tum Turkiye’de aile hekimlerinin bir yil boyunca urettikleri recete verilerinin incelendigi en kapsamli calismadir. Calisma verilerine gore, ulkemizde aile hekimleri tarafindan yazilan her dort receteden biri antibiyotik icermektedir. Ulkemizin guney ve guneydogu bolgesinde bu oran daha da yuksektir. En cok genis spektrumlu antibiyotikler recete edilmektedir. Ulkemiz genelinde akilci ilac kullanimi hedeflerine ulasilmasi icin ileri arastirma ve egitim faaliyetlerine ihtiyac vardir.