[Antibiotics--do sales statistics inform about abuse?].
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Anti-Bacterial Agents↗
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Sales statistics in the control of drug abuse in Norway.
The system of monitoring the patterns of prescription and consumption of addictive drugs by utilizing computerized data on prescriptions collected in pharmacies throughout Norway is described. The number of prescriptions for narcotic drugs issued in out-patient facilities substantially decreased in the period 1970-1980. Statistics also indicate a decrease in the sale of barbiturates and sedative-hypnotics during the period 1974-1980, while the sale of benzodiazepines increased during the same period. The monitoring system provides reliable information on the use of legally prescribed drugs, which proves useful to the authorities in undertaking appropriate control measures of such drugs.
Adult↗
Sources of information on drug usage in Sweden.
Based on sales statistics, prescription habits and figures, interviews, and, in certain instances, on determinations of drug plasma levels, various aspects of drug usage in Sweden are examined. The working of the drug regulatory agency in Sweden is elucidated against the background of the above sources from which drug usage information is obtained.
Adolescent↗
Comparative consumption of antidiabetic drugs in Britain, France and Germany.
With the aid of IMS, a database of drug sales statistics, the quantities (expressed in Defined Daily Doses per 1000 inhabitants and per day) of antidiabetic drugs prescribed from 1978 to 1987, in Britain, France and the Federal Republic of Germany has been compared.
Drug Utilization↗
Over-the-counter sales of drugs in Sweden 1976-1983.
The over-the-counter (OTC) sales of drugs were estimated by subtraction of sales on prescription and to hospitals from total drug sales in Sweden during the period 1976-1983. Increased sales of antitussives and decreased sales of expectorants characterized cough remedies. Making topical nasal decongestants available as OTC drugs immediately resulted in a large and increasing volume of OTC sales. Among analgesics, sales of acetaminophen and acetylsalisylic acid + caffeine combinations increased, while those of other groups decreased. Drugs for disorders of the alimentary tract were second to analgesics in the numbers of packs sold; amongst them antacids and laxatives dominated. Laxative sales decreased due to decreased sales of stimulant preparations. Vitamin C and multivitamin preparations dominated OTC vitamin sales. The sales of topical corticosteroids, only available as OTC drugs during the last quarter of 1983, were substantial. The OTC drug sales statistics reflect patterns of self-medication and may be used to monitor this important part of health care.
Humans↗
Continuous recording of drug prescribing in Sweden 1974-1983. Methods and examples of utilization of data.
Drug prescribing in Sweden under the National Insurance Act has been continuously recorded since 1974. A random sample of 1 in 288 is drawn from the about 24 million prescriptions issued yearly and the following data are recorded: dispensing pharmacy, type of prescription, year and month of dispensing, year of birth and sex of the patient, trade name, quantity, dosage, and price of the drug. The numbers of prescriptions of drugs free of charge increased by 32% between 1974 and 1983, while that of price deducted drugs decreased by 7%. The national cost of drugs rose sharply during the period. The per capita cost of drugs to persons aged greater than or equal to 75 years was more than eight-fold higher than for persons aged less than or equal to 14 years. A two-fold difference in the number of prescription items was found between women and men, and there were nine- to ten-fold differences between age-groups. Total prescribing varied modestly over time, as did the prescribing to most patient groups and for most groups of drugs. Exceptions to this were prescribing to children, particularly of antiallergic drugs for which a 50% increase was observed between 1974 and 1975, mainly due to increased prescribing of phenylpropanolamine. The recording of prescriptions as described is useful for early identification of new patterns of drug use and for mapping drug utilization and drug dosages in different age groups. The system is particularly powerful as a complement to other methods for recording drug use in Sweden, e.g. wholesale sales statistics and individual prescription monitoring in the county of Jämtland.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Analgesic consumption in the Federal Republic of Germany. The extent and the risk groups].
An analysis of still unpublished sales statistics shows that during 1976-1983 the annual sales of all analgesic package units remained relatively stable (about 115 million units per year), while the consumption of large packings mostly preferred by analgesic abusers increased from 8.13 to 11.28 million (units of 100 tablets). The annual per capita consumption of analgesic substances (1983) was 18.2 g. Among these, drugs containing salicylate and phenazone headed the list, whereas phenacetin consumption is increasingly on the downgrade (0.87 g per capita). 95% of all analgesics are used outside of the clinics. Furthermore, 80% of them are purchased on the prescription-free market. High consumption of analgesics can be assumed in 5% of the normal population. Analgesic abuse is more prevalent in women, especially in some industrial areas.
Analgesics↗
Measurement of drug utilization in Sweden: methodological and clinical implications.
The available sources of information on drug utilization in the Swedish population at large are reviewed. They comprise whole-sale statistics, drug deliveries to hospitals and prescription data. Drug consumption is preferably expressed in defined daily doses (DDD) per capita, where DDD is the average recommended dose on the major indication of the drug. Under ideal circumstances--drugs used continuously on one indication--the number of DDDs per population ought to agree with morbidity data. This turned out to be the case with antidiabetic drugs. The pitfalls with this unit of measurement include major discrepancies between recommended and prescribed doses, and the use of the drug on vastly different indications (such as neurosis and psychosis in the case of neuroleptics). Nevertheless, the DDD methodology may serve as a therapeutic audit in attempts to follow and influence therapeutic habits of health personnel in hospitals and primary health care. Wholesale data combined with individual-based prescription data are particularly useful in this regard.
Data Collection↗
Drug related admissions to medical wards: a population based survey.
1. In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2. Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3. The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Noncompliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4. The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5. Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
A 1-year follow-up of prescribing patterns of analgesics in primary health care.
The prescription of analgesics and anti-inflammatory drugs (analgesics) was studied using computerized patient records from a Finnish health centre with a population base of some 27,000 inhabitants. A random sample of every fifth patient visiting the health centre in 1986 was chosen. This study sample consisted of 4,577 patients with 17,021 physician contacts and altogether 14,035 prescriptions during the 1-year follow-up: of these analgesics comprised 14.8%. The proportion of the study population who received at least one analgesic prescription was 23 +/- 1.2% (95% CI). The use of physician contacts as a base revealed 10.7 +/- 0.5% (95% CI) of the contacts with an analgesic prescription. The exposure to analgesics among males increased with age from 17% for those aged 15-34 years to 34% for those aged 75 years or more. Among women, exposure to analgesics increased from 17% (15-34 years) to 41% (75 years or more). Most of patients who received analgesic prescriptions were incidental users (one or two analgesic prescriptions per year). Only 4% of women and 3% of men were categorized as heavy users of analgesics (seven or more analgesic prescriptions per year). The proportion of heavy users increased with age and was highest in the oldest age-group (75 years or more). In order to make informed policy judgements about drug use in society, we need routine sales statistics and patient-specific drug-use data such as those presented in this paper.
Adolescent↗
Epidemiology of adverse reactions to carbamazepine as seen in a spontaneous reporting system.
A survey was made of 505 reports on 713 adverse reactions to carbamazepine submitted to the Swedish Adverse Drug Reactions Advisory Committee from 1965-1987. For the period after 1972, the relation between the reports and sales statistics could be investigated. The total incidence of reported adverse reactions to carbamazepine was 4.5 per million defined daily doses (DDD), corresponding to 2.7 per million prescribed daily doses (PDD). Most often reported were skin reactions (48%), but reports on haematological (12%) and hepatic disorders (10%) were also frequent. Virtually all hepatic disorders and severe skin reactions, as well as the majority (60%) of the haematological reactions, occurred within the first 2 months of treatment. In view of the very low incidence of reported serious blood dyscrasias, such as pancytopenia (0.04/million PDD) and agranulocytosis (0.06/million PDD), continuous haematological monitoring seems to be of little value. The elderly appear to be at increased risk of developing blood dyscrasias and liver reactions, and alcohol abusers seem to represent a high-risk group for developing serious skin reactions.
Age Factors↗
Glaucoma prevalence in the Nordic countries. Estimates based on glaucoma drug consumption.
Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population greater than 40 years), lowest in Denmark (0.76% in the same age group). The prevalence in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre-supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.
Adult↗
[Gingival hyperplasia induced by calcium channel blockers. Rare or frequent in Norway?].
Sales statistics indicate that the number of Norwegians treated with calcium channel blockers increased from about 50,000 in 1986 to about 83,000 in 1991 (last year: nifedipine 39%, verapamil 27%, amlodipine 21%, diltiazem 10% and felodipine 3%). In spite of widespread use, only one report on gingival hyperplasia induced by calcium channel blockers has been received by the Norwegian Adverse drug reaction committee. The incidence of this adverse reaction is uncertain, but the few controlled studies that have been performed indicate that it may be as high as 15% in patients on long-term treatment, at least with nifedipine. This corresponds to nearly 5,000 cases among the about 32,000 users of nifedipine. Norwegian physicians and dentists are asked to report cases of gingival hyperplasia induced by calcium channel blockers. Although the voluntary report system is fraught with uncertainty, it is hoped that, in a relatively small and surveyable drug market as the Norwegian, the reporting may provide some relevant information, e.g. to allow comparison of the potential of the various calcium channel blockers to induce this adverse effect. A Norwegian controlled study on gingival conditions among long-term users of calcium channel blockers is in its initial stage. It may be of interest to compare the results of this study with the indications obtained from the spontaneous reporting on the incidence of this adverse effect, which is relatively easy to diagnose.
Adult↗
Trends in tobacco use in Europe.
Tobacco consumption in Europe can be estimated from several sources, including sales statistics and population surveys. The first source provides a reasonable estimate of total tobacco consumption, whereas the second gives estimates of the prevalence of smokers by sex and age. In 1950, daily cigarette consumption by adults in European countries varied between 1.7 in Portugal and 6.9 in Ireland, the corresponding US consumption being 8.9. In 1989, the variation was much smaller, ie, between 3.5 in the Netherlands and 10.1 in Greece. In the countries where consumption was high in 1950, maximum consumption was achieved around 1975, followed by stabilization or reduction. In other countries, where consumption was low in 1950, it is still increasing. In a 1987 European survey, the proportion of current smokers varied between 33% in Portugal and 46% in Denmark. Much of this difference comes from the low prevalence of smoking habits in the adult female population of southern Europe.
Europe↗
[Change of insulin strength in Norway--a study of an information campaign].
This article describes and discusses the effects of an information campaign carried out in 1987 when the strength of the insulin solution was changed from u-40 to u-100. The data comprised drug sales statistics, records of errors, questionnaires to pharmacies and hospitals and press cuttings. The campaign was organized by a group of experts appointed by the Directorate of Health. Local activities were carried out by pharmacies and hospitals, which proved to be effective information channels. Almost all diabetics changed to u-100 over a three-month period. We recorded incidents of serious erroneous prescribing and administration of insulin, but no deaths or irreversible injuries. It was more difficult to reach target groups of health personnel in the primary health care. The change led to a distinct and probably permanent rise in the sale of insulin in Norway.
Drug Information Services↗
The use of chewing tobacco and snuff in Canada, 1986.
This paper reviews current data relating to the use of smokeless tobacco products in Canada. Sources of data include production, disposition, and sales statistics; special population surveys, and estimates obtained from the 1986 Labour Force Survey smoking supplement. In Canada, the use of smokeless tobacco products is confined to the male population. About 0.7% of males over age 15 use chewing tobacco and 0.4% use snuff. The pattern of use is similar to that of the United States in the early 70s. Prevalence rates for both substances tend to be higher in older age groups. Men employed in outdoor occupations are more likely to use chewing tobacco or snuff. Chewing tobacco use tends to be more prevalent in eastern Canada and snuff use in western Canada. The low national prevalence estimates conceal the relatively high usage rates among sub-populations. Among Inuit youth in the Northwest Territories in 1982, 25% of the 10-14 age group used smokeless tobacco.
Adolescent↗
A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.
Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.
Adult↗
Clostridium difficile and antibiotic associated diarrhoea in Sweden.
Distribution of age and sex among patients with Clostridium difficile enterocolitis shows an increased ratio female: male (3:1) in age group 20 to 40 years and a corresponding 2:1 ratio in patients over 70 years of age, the latter group constituting 45% of 505 patients investigated. Being the only laboratory in Sweden performing cytotoxin-assay from cases of C. difficile enterocolitis during 1979-1981, we have observed that the frequencies with which clindamycin/lincomycin are associated with C. difficile enterocolitis have decreased from 30% (1979) to 9% (1981) while the role of cephalosporins has increased from 18% to 29%. Corresponding figures for the penicillins are 31% and 47% for the respective years. Against a background of sales statistics of these antibiotics in Sweden the risk of contracting C. difficile enterocolitis is appreciated for clindamycin/lincomycin and the cephalosporins in comparison to that of the penicillins. These calculations yielded a 63 times greater risk for clindamycin/lincomycin and a 36 times greater risk for the cephalosporins compared to that of penicillins. The susceptibility patterns of 96 clinical isolates of C. difficile are given showing an increased resistance to ceftriaxon, cephalotin, cefoperazone, cefoxitin and moxalactam, as compared to the susceptibility to other antibiotics. The cytotoxin and the enterotoxin produced by C. difficile are described. In our hands the enterotoxin causes hemorrhagic fluid accumulation and gross mucosal damage to rabbit ileal mucosa while the cytotoxin causes only mild inflammatory changes. It is pointed out that the assay demonstrating toxin in cases of C. difficile enterocolitis currently used in practise only measures the presence of cytotoxin and that a routine method for demonstration of enterotoxin is lacking to date.
Adolescent↗