Antibiotic use in elderly patients in ambulatory care: A comparison between Hungary and Sweden

Ikhwan Yuda Kusuma; Maria Matuz; Réka Bordás; Maria Juhasz Haverinen; Muh Akbar Bahar; Edit Hajdu; Ádám Visnyovszki; Roxána Ruzsa; Péter Doró; Zsófi Engi; Dezső Csupor; Ria Benko

doi:10.3389/fphar.2022.1042418

Antibiotic use in elderly patients in ambulatory care: A comparison between Hungary and Sweden

Front Pharmacol. 2022 Nov 17:13:1042418. doi: 10.3389/fphar.2022.1042418. eCollection 2022.

Authors

Ikhwan Yuda Kusuma^{1

2}, Maria Matuz^{1

3}, Réka Bordás¹, Maria Juhasz Haverinen⁴, Muh Akbar Bahar^{1

5}, Edit Hajdu⁶, Ádám Visnyovszki⁶, Roxána Ruzsa¹, Péter Doró¹, Zsófi Engi¹, Dezső Csupor^{1

7}, Ria Benko^{1

3

8}

Affiliations

¹ Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary.
² Pharmacy Study Program, Universitas Harapan Bangsa, Purwokerto, Indonesia.
³ Albert Szent-Györgyi Health Centre, Central Pharmacy, University of Szeged, Szeged, Hungary.
⁴ Public Healthcare Services Committee, Stockholm, Sweden.
⁵ Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia.
⁶ Albert Szent-Györgyi Health Centre, Department of Internal Medicine Infectiology Unit, University of Szeged, Szeged, Hungary.
⁷ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
⁸ Albert Szent-Györgyi Health Centre, Emergency Department, University of Szeged, Szeged, Hungary.

Abstract

Background: The elderly use antibiotics frequently due to their increasing infection susceptibility. Given the high and increasing proportion of elderly in the population, their antibiotic use is substantial. Objective: This study aimed to compare antibiotic use in the elderly in the ambulatory care sector between Hungary and Sweden. Methods: This retrospective, descriptive, cross-national, comparative study included antibacterial use data from the Hungarian National Health Insurance Fund and the Swedish eHealth Agency. Antibiotic use (anatomical therapeutical chemical: J01) was expressed as the number of prescriptions/1000 inhabitants/year or month and was further stratified by age and sex. Results: Antibiotic exposure was higher in the Hungarian elderly population (649.8 prescriptions/1000 inhabitants/year) compared to its Swedish counterparts (545.0 prescriptions/1000 inhabitants/year). Hungary had a similar scale of antibacterial exposure across all elderly age subgroups, with different trends in males and females, while Sweden had a stepwise increase in antibiotic exposure by age in both sexes. The seasonal fluctuation was high in Hungary and reached a peak of 80.7 prescriptions/1000 inhabitants/month in January 2017, while even antibiotic use was detected throughout the year in Sweden. The pattern of antibiotic use in the elderly considerably differed between the two countries. Penicillin and beta-lactamase combinations, such as co-amoxiclav, were more frequently used in Hungary than in Sweden (19.08% vs 1.83% of corresponding total ambulatory antibiotic use). Likewise, quinolones were more commonly used in Hungary than in Sweden (34.53% vs. 9.98). The elderly in Sweden were mostly prescribed narrow spectra penicillins (26.71% vs. 0.29% in Hungary). Conclusion: This cross-national comparison revealed important differences in all aspects of antibiotic use in the elderly between the two countries. The identical scale and pattern of antibiotic use cannot be anticipated due to the poorer health status of the Hungarian elderly population. However, the substantial differences indicate some room for improvement in the antibiotic prescription for the Hungarian elderly.

Keywords: ambulatory care; antibacterials; antibiotic stewardship; cross national comparison; drug utilization study; elderly; prescrptions/1000 inhabitants/year; public health.