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\begin{document}

\title{Monitoring the community use of antibiotics in Italy within the National
Action Plan on Antimicrobial Resistance}



\author[1]{Agnese  Cangini}%
\author[1]{Filomena Fortinguerra}%
\author[1]{Aurora Di Filippo}%
\author[1]{Andrea Pierantozzi}%
\author[2]{Roberto Da Cas}%
\author[3]{Federico Villa}%
\author[1]{Francesco  Trotta }%
\author[4]{MariaLuisa Moro}%
\author[4]{Carlo Gagliotti}%
\affil[1]{Agenzia Italiana del Farmaco}%
\affil[2]{National Institute of Health}%
\affil[3]{Università del Piemonte Orientale Amedeo Avogadro Biblioteca del DIGSPES}%
\affil[4]{Agenzia sanitaria e sociale regionale Regione Emilia-Romagna}%


\vspace{-1em}



  
  \date{May 06, 2024}


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\begin{abstract}
Background: In Italy both the consumption of antibiotics and the
prevalence of bacterial resistance are higher than in other European
countries. In 2017, the first National Action Plan on Antimicrobial
Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two
National Reports on Antibiotics' use in the human setting have been
published. The article's aim is to describe the pattern of antibiotics
consumption in the community setting in Italy from 2013 to 2018.
Methods: In order to analyse the consumption for reimbursed antibiotics
dispensed by community pharmacies different data sources were used.
Consumption was measured in terms of Defined Daily Dose (DDD),
prescriptions or prevalence of use. Results: In 2018, the consumption of
antibiotics in Italy amounted to 16.1 DDD per 1,000 inhabitants per day.
The rates of consumption by geographical area were: 12.7 DDD in the
North, 16.9 in the Centre and 20.4 in the South. The use was greater in
the extreme age groups than in the population aged from 20 to 64 years.
The consumption was higher in winter season with high peaks in the
incidence of flu syndromes. In the paediatric population, a utilization
rate of 1,010 prescriptions per 1,000 children, with a prevalence of use
of 40.8\%, was found. Conclusion: The study provides useful information
on geographical variability of antibiotics' use in Italy to guide
decision makers in the introduction of tailored interventions, as
suggested by PNCAR, aimed at promoting a more rational use of
antibiotics for humans and reducing antimicrobial resistance.%
\end{abstract}%



\sloppy


\textbf{Corresponding author contact information:} Agnese Cangini, Via
del Tritone, 181-00187, Rome, Italy, a.cangini@aifa.gov.it

\textbf{Principal Investigator statement:} This manuscript is not a
report on primary research performed with human subjects/patients; thus,
there is no Principal Investigator for this paper.

\textbf{What is already known about this subject:}

\begin{itemize}
\tightlist
\item
  Antimicrobial resistance (AMR), which is considered a serious threat
  to public health worldwide, is correlated to the use of antibiotics.
\item
  Antimicrobial stewardship programs need to be adapted to specific
  settings taking into account consumption patterns and prescription
  determinants. The assessment of geographical variability, patient
  characteristics and the possibility of linking prescriptions to
  clinical diagnoses enables intervention models to be adapted to the
  context making them more effective.
\item
  In Italy both the community consumption of antibiotics and the
  prevalence of bacterial resistance are higher than in other European
  countries.\textbf{~}
\end{itemize}

\textbf{What this study adds}

\begin{itemize}
\tightlist
\item
  This study provides a model of analysis and presentation of antibiotic
  consumption data that can be replicated in other countries: different
  information sources and indicators are used (for example,
  prescriptions and prevalence of use are used for children); there is a
  strong focus on the informative value of data with disaggregation
  based on geographic areas and type of patients; information on
  diagnoses from a sentinel network of general practitioners is also
  provided; the seasonality of prescriptions is shown in parallel with
  the trend of flu syndromes.
\item
  The analysis and presentation of these data (partly already used in
  national reports) is not only a surveillance activity but also acts as
  an implementation tool within the National Action Plan on
  Antimicrobial Resistance (PNCAR, 2017-2020) to allow the comparison
  between regions and promote the improvement actions already adopted in
  those settings that have better prescriptive profiles.
\item
  This study fills an information gap on Italy's consumption and
  prescribing patterns which are presented in aggregate form in European
  reports, not highlighting the profound differences between areas both
  in terms of quantity and type of antibiotics used. In addition, the
  articles published so far are often in Italian and concern only some
  regions of the country.
\end{itemize}

\textbf{Hosted file}

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