Antibiotics. Aifa: “Consumption is still falling in Italy but we are still above the European average. 24% purchased out of pocket while being refundable. Strong risk of inappropriateness”

The new Aifa report has been published. In 2021, about 3 out of 10 citizens received at least one prescription for antibiotics, with a prevalence that increases with age, reaching 50% in the over 85s. The increase in the share of antibiotics purchased privately is worrying and it would be good for Aifa greater monitoring of the appropriateness of these non-NHS consumption. THE REPORT

03 APR –

In 2021 the trend of reducing the use of antibiotics in Italy will continue (-3.3% compared to 2020), although consumption is still higher than that of many European countries.

The new detects it Report on the use of antibiotics in Italy by the recently published AIFA National Observatory on the Use of Medicines (OsMed) which points the finger at a growing phenomenon: that of the private consumption of antibiotics.

In fact, despite the fact that they are class A drugs paid for by the NHS, one package out of four is purchased directly by the citizen at his own expense without going through the NHS and it is precisely on this channel that Aifa observes how “considering the growing importance of private purchase in terms of consumption and spending, it becomes increasingly urgent to monitor its appropriateness and study the factors that influence the observed trend”.

The Aifa report then confirms a wide regional variability in consumption, with significant margins for improvement of the prescriptive appropriateness especially in the Southern Regions.

In the analysis on the use of antibiotics in the subsidized care regime, some are also included focus on prescribing in the pediatric population and the elderly, on fluoroquinolone prescriptions in specific subgroups of the population and on the use of antibiotics in patients with chronic obstructive pulmonary disease (COPD).

The Report also examines the use of antibiotics in hospital settings, the private purchase of class A antibiotics, the consumption of non-systemic antibiotics and indicators of prescribing appropriateness in the field of general medicine.

The new edition also presents a section on the network of microbiology laboratories and, in accordance with the provisions of the National Antimicrobial Resistance Contrast Plan (PNCAR) 2022-2025, and a section that takes into consideration the use of antibiotics in the field veterinarian.

Finally, as in recent years, the Report provides an assessment of the impact of the COVID-19 pandemic on antibiotic consumption in the context of pharmaceutical assistance and purchases by public health structures, which also includes the first half of 2022.

The temporal trends of consumption and the important differences in the prescriptive patterns between geographical areas that emerge from the data of the Report, Aifa notes, “highlight the importance of continuing to monitor, both at a national and regional or local level, the indicators of consumption and quality of the prescription of antibiotics in Italy, as also recommended by the new PNCAR 2022-2025”.

These are the most significant data of the new report:

• The trend of reducing the consumption of antibiotics in Italy continues: -3.3% in 2021 compared to 2020
• In 2021, about 3 out of 10 citizens received at least one prescription for antibiotics, with a prevalence that increases with age, reaching 50% in the over 85s.
• In the pediatric population, the greatest consumption is concentrated in the age group between 2 and 5 years, in which about 4 out of 10 children received at least one prescription of antibiotics during the year.
• 76% of the doses used were provided by the National Health Service (SSN).
• Almost 90% of the antibiotics reimbursed by the NHS are distributed on the territory (under an agreed assistance regime).
• More than a quarter of consumption at a territorial level (26.3%) corresponds to private purchases of antibiotics reimbursable by the NHS (class A). In 2021, the average daily consumption of class A antibiotics purchased privately by citizens was in fact equal to 4.1 doses per 1000 inhabitants, or 24% of the total antibiotic consumption, while the per capita expenditure was 2.25 euros (134 million euro), representing 17% of the total expenditure on antibiotics and 8.8% of the entire private expenditure on class A drugs.
• Penicillins in combination with beta-lactamase inhibitors confirm the class with the highest consumption (36% of total consumption), followed by macrolides and fluoroquinolones.
• There is still a wide regional variability in consumption paid by the NHS, which is greater in the South than in the North and in the Centre. In addition, the largest reductions were recorded in the Northern regions (-6.1%), while in the South they were more contained (-2.2%).
• In the Regions of the South there is a predilection for the use of second choice antibiotics.
• Overall, consumption in Italy remains higher than in many European countries.
• Italy is confirmed as one of the European countries with the greatest use of broad-spectrum molecules, with the greatest impact on antibiotic resistance and therefore considered second-line, with a worsening trend in the last two years.
• Italy is also one of the countries with the lowest share of antibiotics of the “Access” group (47%), considered antibiotics of first choice, which according to the WHO should constitute at least 60% of total consumption.
• In the hospital setting, an increase in the use of antibiotics indicated for the treatment of infections caused by multi-resistant microorganisms is observed in particular.
• Both consumption under the agreed care regime and purchases by public healthcare facilities increased in the first half of 2022 compared to the same period of the previous year.

03 April 2023
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