2024/09/20 by Lilly Josephine Bindel, Roland Seifert
Immunology and Microbiology · Medicine · #Antibiotic Use and Resistance #Drug-Induced Adverse Reactions #Pharmaceutical studies and practices
paper · pdf · doi:10.1007/s00210-024-03435-7
crossref issued 2024/09/20 · crossref published 2024/09/20 · crossref published-online 2024/09/20 · openalex publication_date 2024/09/20 · crossref created 2024/09/24 · crossref published-print 2025/03/01 · crossref deposited 2025/03/18 · openalex created_date 2025/10/10 · crossref indexed 2026/07/30 · openalex updated_date 2026/08/03
Previous research from our group revealed a strong association between daily defined dose (DDD)-costs and -prescriptions of antibacterial drugs in Germany ( https://pubmed.ncbi.nlm.nih.gov/38842562/ ; https://pubmed.ncbi.nlm.nih.gov/39042156/ ). These data indicate that low costs are major driver of high prescription numbers. This study examines the relationship between bacterial resistance and DDD-prescriptions of antibacterial drugs using data from the Arzneiverordnungsreport (AVR) from 2008 to 2022 and the Antibiotic Resistance Surveillance (ARS) statistics provided by the Robert Koch Institute (RKI). We hypothesized that semi-rational or irrational prescribing behavior of antibacterial drugs is evident in Germany, i.e., prescriptions are driven to a greater extents by low DDD-costs than bacterial resistance. A bivariate correlation analysis was performed to test these models. Our data point to irrational prescribing behavior for amoxicillin, cefuroxime axetil, doxycycline, nitrofurantoin, ciprofloxacin, and clarithromycin. For amoxicillin clavulanic acid and sulfamethoxazole-trimethoprim, data point to semi-rational prescribing. For no antibacterial drug, a model pointing to rational drug prescribing was found. In conclusion, our study shows that DDD-costs exert a more significant influence on DDD-prescriptions than bacterial resistance, indicating that economic factors, rather than scientific evidence, primarily drive antibacterial drug prescriptions in outpatient settings in Germany. It will be important to conduct similar studies on the prescription of antibacterial drugs in other countries. It will also be important to study the relation between DDD-costs and -prescriptions for other drug classes and assess the scientific basis for these relations.