Susanne Barbara Schink (Berlin / DE), Amel Mlaouhi-Müller (Berlin / DE), Wiebke Wittmüß (Berlin / DE), Marc Schneider (Berlin / DE), Marcel Feig (Berlin / DE), Tim Eckmanns (Berlin / DE), Jörn Schleeff (Berlin / DE), Muna Abu-Sin (Berlin / DE), Julia Hermes (Berlin / DE)
INTRODUCTION
On June 6th, 2023, the European Union published a recommendation on stepping up EU actions to combat antimicrobial resistance and set as target to increase the proportion of antibiotics from the access group as defined in the AWaRe (access, watch, reserve) classification of the WHO to 65% by 2030.
GOALS
We analyzed overall antibiotic prescription volume and access prescription use from 2019 to 2022 in the light of new EU targets for 2030.
MATERIALS & METHODS
We applied the WHO AWaRe classification to all prescriptions issued to outpatients and reimbursed by statutory health insurance by federal state in Germany in 2019-2022. Using Stata 17, we analysed overall prescription numbers and proportion of access prescriptions by federal state and year, and mapped the results with RegioGraph.
RESULTS
Overall, 87% of the population in Germany is covered by statutory health insurance. We could classify 99% of all systemic antibiotic prescriptions to outpatients according to AWaRe criteria.
Prescribing decreased significantly with the COVID-19 pandemic in Germany from 26.6 million (mil.) prescriptions in 2019 to 19.2 mil. in 2020, stayed low throughout 2021 (17.2 mil.) and in the first three quarters of 2022, but exceeded pre-pandemic times in the last quarter of 2022 (total 2022: 22.3 mil.). By federal state, decrease ranged from -12.4% in Berlin and -13.8% in Saxony to -20.3% in Rhineland-Palatinate and -22.2% in both Saarland and Schleswig-Holstein.
Overall access prescriptions in Germany increased from 51% in 2019 to 55% in 2022 [graph]. Geographical differences point to a smaller proportion of access use in mainly eastern regions compared to western regions, with lowest proportion in Mecklenburg-Western Pomerania (48.4%), Hessen (48.9%) and Saxony-Anhalt (48.9%) and highest in Bremen (63.1%) in 2022.
SUMMARY
While the overall number of antibiotic prescriptions decreased, the proportion of access prescriptions grew. Both changes vary regionally across Germany. This points to nuanced challenges to further improve antibiotic stewardship measures in the outpatient sector to meet EU 2030 targets.