Oral antibiotics prescribing patterns and associated diarrhea risk: Public health implications.

IF 2.1 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Public Health Research Pub Date : 2026-09-10 eCollection Date: 2026-07-01 DOI:10.1177/22799036261480287

Zorica Naumovska, Emilija Atanasovska, Beti Djurdjic, Kristina Mladenovska, Tanja Petreska Ivanovska, Nikola Geskovski, Katerina Anceska Netkovska, Katerina Goracinova, Renata Slaveska Raichki, Dushko Shalabalija, Ljubica Mihailova, Teodora Tasevska, Lina Livrinska Trpeska, Maja Simonoska Crcarevska

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引用次数: 0

Abstract

Background: Inappropriate antibiotic use contributes to antimicrobial resistance and adverse drug reactions (ADR), including antibiotic-associated diarrhea (AAD), underscoring the importance of WHO AWaRe recommendations for rational prescribing. Clinical evidence supports the use of specific probiotic strains to reduce AAD risk, with strain-specific recommendations that should be adapted to regional contexts.

Objectives: To assess oral antibiotic consumption in the Republic of North Macedonia (2011-2022), evaluate prescribing patterns according to the WHO AWaRe classification, identify antibiotics associated with a higher burden of AAD, and determine the availability of evidence-supported probiotics for AAD prevention.

Design: Observational pharmaco-epidemiological study integrating antibiotic utilization data, pharmacovigilance signals, and evidence synthesis from systematic reviews and market analysis.

Methods: Reimbursed oral antibiotic data (ATC J01) were obtained from the National Health Insurance Fund. Gastrointestinal ADR reports were extracted from EudraVigilance and FAERS. Diarrhea risk was estimated using SmPC frequency categories and normalized pharmacovigilance indicators. Systematic reviews and meta-analyses were used to identify probiotic strains with evidence for AAD prevention, and online pharmacy surveys assessed market availability.

Results: Penicillins and cephalosporins predominated in antibiotic use. Amoxicillin/clavulanic acid, cefixime, and clindamycin ranked highest for diarrhea risk based on combined utilization and pharmacovigilance indicators. Saccharomyces boulardii and Lactobacillus rhamnosus GG showed the strongest evidence for AAD prevention. Considerable variability was observed in probiotic product composition and reporting across the market.

Conclusion: Findings highlight antibiotics with higher AAD-related public health burden and support antimicrobial stewardship strategies, including evidence-based probiotic co-administration.

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口服抗生素处方模式和相关腹泻风险：公共卫生影响

背景：不适当的抗生素使用会导致抗菌素耐药性和药物不良反应（ADR），包括抗生素相关性腹泻（AAD），这突出了世卫组织AWaRe关于合理处方的建议的重要性。临床证据支持使用特定的益生菌菌株来降低AAD的风险，并提出针对特定菌株的建议，应根据地区情况进行调整。目的：评估北马其顿共和国（2011-2022年）的口服抗生素消费情况，根据世卫组织AWaRe分类评估处方模式，确定与AAD较高负担相关的抗生素，并确定有证据支持的AAD预防益生菌的可得性。设计：观察性药物流行病学研究，整合抗生素使用数据、药物警戒信号以及来自系统评价和市场分析的证据合成。方法：从国家健康保险基金获得已报销口服抗生素数据（ATC J01）。从EudraVigilance和FAERS中提取胃肠道不良反应报告。使用SmPC频率分类和标准化药物警戒指标估计腹泻风险。系统评价和荟萃分析用于鉴定具有AAD预防证据的益生菌菌株，在线药房调查评估了市场可获得性。结果：抗生素使用以青霉素类和头孢菌素类为主。根据联合利用和药物警戒指标，阿莫西林/克拉维酸、头孢克肟和克林霉素腹泻风险最高。博拉氏酵母和鼠李糖乳杆菌GG对AAD的预防作用最强。在整个市场中，益生菌产品的组成和报告存在相当大的差异。结论：研究结果强调抗生素与aad相关的公共卫生负担较高，并支持抗菌药物管理策略，包括基于证据的益生菌联合给药。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Public Health Research PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

3.70

自引率

4.30%

发文量

116

审稿时长

10 weeks

期刊介绍： The Journal of Public Health Research (JPHR) is an online Open Access, peer-reviewed journal in the field of public health science. The aim of the journal is to stimulate debate and dissemination of knowledge in the public health field in order to improve efficacy, effectiveness and efficiency of public health interventions to improve health outcomes of populations. This aim can only be achieved by adopting a global and multidisciplinary approach. The Journal of Public Health Research publishes contributions from both the “traditional'' disciplines of public health, including hygiene, epidemiology, health education, environmental health, occupational health, health policy, hospital management, health economics, law and ethics as well as from the area of new health care fields including social science, communication science, eHealth and mHealth philosophy, health technology assessment, genetics research implications, population-mental health, gender and disparity issues, global and migration-related themes. In support of this approach, JPHR strongly encourages the use of real multidisciplinary approaches and analyses in the manuscripts submitted to the journal. In addition to Original research, Systematic Review, Meta-analysis, Meta-synthesis and Perspectives and Debate articles, JPHR publishes newsworthy Brief Reports, Letters and Study Protocols related to public health and public health management activities.