(A48) Use of Antibiotics in the ‘Watch’ category of the WHO AWaRe classification in Europe: a DARWIN-EU® multinational network cohort study (EUPAS103381)
Associate Professor Department of Medical Informatics, Erasmus MC Rotterdam, Netherlands
Background: The WHO 2021 AWaRe Classification of Antibiotics ‘Watch list’ includes antibiotic classes with a higher bacterial resistance potential. Following a request from the European Medicines Agency, we studied the use of antibiotics in the Watch category in routine health care settings across data partners in the DARWIN EU(R) network.
Objectives: To investigate the incidence rate, prevalence and duration of use of antibiotics on the WHO ‘Watch list’.
Methods: This multinational network cohort drug utilisation study included individuals with at least one year of database history between 01/01/2012 and 31/12/2021. Data sources included primary care records from NL (Integrated Primary Care Information Project (IPCI)), ES (the Information System for Research in Primary Care (SIDIAP)), the UK (Clinical Practice Research Datalink GOLD (CPRD GOLD)), ambulatory specialist and general practice data from DE (IQVIA Disease Analyzer Germany), hospital records from ES (Parc Salut Mar Barcelona, Hospital del Mar (IMASIS)), and FR (Bordeaux University Hospital (CHUBX)). The annual period prevalence and incidence of use for individual antibiotics and antibiotic classes were assessed at the population level, as well as the patient-level duration of use which was assessed among new users, defined as those who had not been exposed to the index antibiotic of interest for 30 days prior to the first prescription.
Results: During the study period, 78 of the 137 ingredients on the WHO Watch list were observed in at least one of the data sources. Few antibiotics had an incidence rate > 100/100,000 person-years (PY). The antibiotics with the highest incidence rates were similar across databases: in primary care, ciprofloxacin, clarithromycin, fosfomycin, and azithromycin were frequently prescribed, as were ceftriaxone, vancomycin, and meropenem in secondary care. Antibiotic use in children was lower than in adults, and increased with age. Prevalence of antibiotic use mirrored incidence rates, and the median duration of an antibiotic exposure period in primary care was around one week, with the exception of fosfomycin, where the median duration of use was mostly one day. The median duration of antibiotic use in secondary care was shorter than in primary care.
Conclusions: Most of the 78 antibiotics on the WHO Watch list have incidence rates below 100/100,000 PY. Ciprofloxacin, clarithromycin, fosfomycin, and azithromycin were more frequently used in primary care, while ceftriaxone, cefuroxime, piperacillin-tazobactam, and vancomycin were mainly used in secondary care. Overall, antibiotic use increased with age, with the average duration of use being shorter in secondary care than in primary care.
