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GUIDELINES FOR THE GOOD USE OF ANTIBIOTICS IN THE COMMUNITY: A MULTI-DISCIPLINARY EXPERIENCE OF THE LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA

European Statement

Clinical Pharmacy Services

Author(s)

Sergio Mezzadri(3), Sofia Filippini(1), Annamaria Valcavi(1), Alessandra Ferretti(1), Simone Filippi(1), Francesco Marchi(1), Lucrezia Manghi(1), Marco Massari(2), Alessandra Fonto(3), Federica Violi(3), Alberto Gandolfi(4), Lina Bianconi(4), Elena Casini(4), Valentina Pinna(4), Marcellino Bardaro(5), Giuseppe Russello(5), Paola Nardini(5), Laura Cavazzuti(6), Davide Maria Lucchesi(7), Lidia Fares(1), Federica Gradellini(1), Cinzia Gentile(8)
1- Pharmaceutical Department, Local Health Authority of Reggio Emilia
2- Infectious Diseases, Local Health Authority of Reggio Emilia
3- Primary Care Department, Local Health Authority of Reggio Emilia
4- General practitioner, Local Health Authority of Reggio Emilia
5- Microbiology, Local Health Authority of Reggio Emilia
6- Medical Direction, Local Health Authority of Reggio Emilia
7- Emergency Medicine, Local Health Authority of Reggio Emilia
8- Health Management, Local Health Authority of Reggio Emilia

Why was it done?

The overuse and misuse of antibiotics in Italy has led to the development of bacterial resistance. To minimise the emergence of antimicrobial resistance it is essential to improve best practices for antibiotic use in a “one health” approach.

What was done?

Guidelines for antibiotic prescriptions in the community to support general practitioners in the diagnosis, management and treatment of common bacterial infections in adults. The project aims to promote the use of narrow-spectrum antibiotics, encouraging the prescription from “Access” group (based on the AWaRe classification).

How was it done?

Guidelines were developed for respiratory, urinary, gastroenteric, and cutaneous infections based on local resistance patterns, literature evidences and local organization. For each antibiotic, a fact sheet with pharmacological and safety indications is available.
• The writing involved a multidisciplinary antibiotic management team (pharmacists, general practitioners, infectious disease specialists, microbiologists and emergency department physicians).
• The review was conducted by Primary Care Units (NCP).
• The documents were discussed during training events and published on a dedicated webpage.
• The effectiveness of the project was measured using drug-consumption indicators, training participation and webpage access.

What has been achieved?

A total of 21 protocols and 16 drug fact sheets were created, presented during training events from October 2023 to May 2024 (8 sessions), with 100% participation of NCP. The results of the first semester of 2024 show an increase in access to the web page, with a monthly average of 496 accesses among 238 users (78% of all general practitioners). Comparing the first semester of 2024 to the same period in 2023, there was a decrease in antibiotic use (11,11 vs. 11,51 defined daily dose per 1000 inhabitants), with a more significant reduction in the first quarter of the year, despite the trends in the 2023-2024 flu season (11,29 vs. 13,16 defined daily dose per 1000 inhabitants).

What next?

The second phase of the project will involve the creation of an app and leaflets for patients. In the meantime, antibiotic consumption data will continue to be monitored and discussed with general practitioners. The expected outcomes also include a more selective referral of patients to the emergency department and greater attention to reports of suspected adverse drug reactions by general practitioners.

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