This study systematically analyzed the antibiotic prescription trends in primary healthcare centers in the Castile and Leon region of Spain, revealing urban-rural disparities and prescription patterns across provinces. It provides a regional perspective for optimizing antibiotic use and controlling antimicrobial resistance.
Literature Overview
The article titled 'Analysis of Antibiotic Prescription Rates in Castile and Leon Region, Spain, 2013–2023', published in the journal Antibiotics, reviews and summarizes changes in antibiotic prescription rates over the past decade in the region, highlighting variations in prescription patterns between urban and rural areas and across provinces. The study utilizes data from the pharmacy information system (Concylia) of Castile and Leon's health services, analyzing metrics such as Defined Daily Doses (DDD). It further compares national and regional prescription rates, showing a decline after a peak in 2015 due to the implementation of the National Antibiotic Resistance Plan (PRAN), followed by an increase after 2021, reaching 2019 levels by 2023. The study also notes that despite a national decline in prescription rates, the region remains above the national average, emphasizing the necessity for region-specific interventions.
Background Knowledge
Antimicrobial resistance (AMR) is one of the most critical global public health challenges of the 21st century. The World Health Organization (WHO) predicts that AMR could cause millions of deaths by 2050. Castile and Leon, being one of Spain's largest and most aging-population regions, has representative antibiotic use patterns in primary healthcare centers. The study analyzed prescription trends of antibiotics in the J01 class (systemic antibacterials), including subclasses such as J01A (tetracyclines), J01C (beta-lactams), and J01FA (macrolides), with particular attention to azithromycin (J01FA10) prescription changes. Since primary healthcare centers account for nearly 90% of antibiotic use, the study highlights the influence of urban-rural disparities and demographic factors, such as aging populations, on prescription patterns. Additionally, the study notes that while specific diagnoses cannot be linked to prescriptions, variations in prescription patterns still reflect differences in population health status and medical practices. These background insights provide a solid theoretical and practical foundation for further analysis.
Research Methods and Experiments
This study adopts a descriptive, observational, ecological design, analyzing electronic prescription data from Castile and Leon's health services between 2013 and 2023 to examine annual and quarterly changes in antibiotic prescription rates and differences in prescriptions between urban and rural primary healthcare centers. It also evaluates prescription patterns of various antibiotic subclasses (J01 group), calculating the percentage change in macrolide and fluoroquinolone prescriptions to assess the appropriateness of prescribing practices. The research team standardized data using the WHO Anatomical Therapeutic Chemical (ATC) classification system and calculated prescription rates by analyzing the relationship between Defined Daily Doses (DDD) and Healthcare Card holders (HCC).
Key Conclusions and Perspectives
Research Significance and Prospects
The study provides data-driven support for optimizing antibiotic use in Castile and Leon, emphasizing the impact of urban-rural disparities, demographic structures, and medical practices on prescription rates. Future research should integrate diagnostic data to evaluate prescription appropriateness and explore the effects of interventions such as public awareness campaigns and physician training on promoting rational antibiotic use. Moreover, the findings can guide policymakers in developing region-specific antibiotic management strategies to reduce resistance development and promote sustainable public health.
Conclusion
This study reveals the dynamic changes in antibiotic prescription rates in primary healthcare centers in Castile and Leon, Spain, between 2013 and 2023, as well as disparities across urban-rural and provincial areas. The overall trend shows a decline in prescription rates after 2015, reaching a minimum in 2020, followed by a gradual recovery, with 2023 rates approaching 2019 levels. Despite a national decline in antibiotic prescriptions, the region remains above the national average, with rural areas exhibiting significantly higher prescription rates than urban areas. Macrolides are more frequently prescribed in urban areas, whereas fluoroquinolones are more common in rural settings, suggesting that prescription behaviors may be associated with regional healthcare resources and demographic structures. The study emphasizes that the aging population and rural demographics are key factors influencing antibiotic prescriptions, recommending enhanced prescription management and patient education in primary healthcare to reduce inappropriate use and delay resistance development. Additionally, the findings support the development of region-specific intervention strategies that integrate healthcare and public health systems to achieve more effective antibiotic stewardship.
