Trends in antibiotic consumption in Spain, 1985-2000

The purpose of this study was to analyse the trend in antibiotics consumption to draw on the National Health System (NHS) over the last 16 years in Spain and its different Autonomous Communities (AC). MATERIAL AND METHOD: Consumption data for all antibiotics used in Spain, either alone or in fixed-dose combinations, were obtained using the database ECOM. This database includes all the packages sold through retail pharmacies and reimbursed by the NHS. Data are expressed as defined dairy doses per 1,000 inhabitants per day (DHD), in accordance with the methodology recommended by the World Health Organization. Demographic data were provided by the National Institute of Statistics. RESULTS: In 1985 the overall consumption of antibiotics was 21.9 DHD, while in 2000 it was 20.4 CHID, It was possible to distinguish three phases over the study period. The first phase laster until 1989, where a mild decreasing trend was observed (-1.1 DHD; -5.0%), mainly due to the fall of fixed-dose combinations of antibiotics and the association of sulfamethoxazole-trimethoprim. The second phase, lasting until 1996, was characterized by a generalized increase in the consumption in all AC, with an average of 2.3 DHD (+ 11.1%), ranging from 0.4 to 4.6 DHD; this increase was mainly due to the marketting of new macrolides, cephalosporins and quinolones. Finally, there was a third phase begining in 1996, where the consumption of antibiotics came into a sustained and generalized decline, ranging from 0.5 to 5.1 DHD, and depending on the AC (national average 2.7 DHD, 11.7% lower than that in 1996). This latter trend was mainly due to the fall of wide spectrum penicillins. Differences between AC regarding the level of consumption were huge over the study period, although the pattern of use was quite similar. There was, for instance, a difference of 10.4 DHD between Region de Murcia and Islas Baleares in 2000, or 9.9 DHD between the former and Madrid in the same year. CONCLUSIONS: The consumption of antibiotics in Spain and all its AC has declined since 1996, probably related. to the campaigns launched by public administrations to promote the rational use of these agents. The main., subgroup involved in this trend is wide-spectrum penicillins, Differences in antibiotics use between AC are too. to be accounted for by different epidemic patterns and, therefore, should be analysed further.