Variability in outpatient antimicrobial consumption in Israel

Background: : Antibiotic consumption has an important effecton microbial resistance. Nationwide data on the comparativeuse of antibiotics in outpatient settings in Israel have onlybeen partially collected and published. The aim of our studywas to analyze the use of antibiotics in the outpatient settingin Israel and assess a number of influencing factors. Materials and Methods: : Defined daily doses per 1,000inhabitants per day (DID) of total antibiotic use, consumptionin different age groups, and consumption of differentantibiotic groups were calculated for the years 2003-2005 inthe districts of Israel. The data was collected from prescriptiondata compiled by the pharmaceutical services of"Clalit Health Services", the largest health maintenanceorganization (HMO) in Israel, covering 55% of the population.Trends in use and variables associated with antibioticconsumption were analyzed. Results: : There was a significant decrease in antibiotic usefrom 2003 to 2005, ranging from 1.8 to 8.2% in the differentdistricts. The highest consumption was noted in the youngestage groups, with more than half of all antibiotics prescribed to children ≤ 18 years of age. Antibiotic consumption was significantlydifferent between the different regions in Israel. Amultivariate analysis revealed that a higher prevalence of diabetesmellitus was the only significant variable associated withantibiotic use. Variability in the use of different antibiotics wasalso found; for example, amoxicillin comprised 19.5-33.4% oftotal antibiotic consumption in the different districts, whilefluoroquinolone consumption ranged from 3.2 to 7.3%. Conclusions: : Outpatient antibiotic use in the populationinsured by "Clalit Health Services" declined between 2003and 2005. Children had the highest consumption rates. Therewere large differences in antibiotic use between geographicregions, and diabetes mellitus was the only variable significantly associated with antibiotic use. We therefore concludethat most of the differences in antibiotic use are likely due todoctor preferences, local routines, and patients' attitudesand expectations.