Comparison of sales and reimbursement data regarding outpatient antibiotic use in a northern Italian Region

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Abstract
To evaluate the accuracy of systemic antibiotic use statistics, based on the reimbursement data of the Emilia-Romagna Region (Italy), focusing on agents prescribed for urinary tract infections.Reimbursement data were obtained from the drug prescription database that includes all outpatient drug prescriptions reimbursed by the Regional Health Service in 2007. Reimbursements were compared to sales data, provided by International Medical Statistics (IMS) Health.The reimbursement data of the Emilia-Romagna Region significantly underestimates the actual use of systemic antibiotics when compared to sales. The overall underestimation of antibiotic use is 19%, ranging from 7% for second-third-generation cephalosporins to 98% for nitrofurantoin. Considering agents prescribed for urinary tract infections (UTIs), use of nitrofurantoin and sulfamethoxazole-trimethoprim are more underestimated while fluoroquinolones and fosfomycin are less underestimated than the average for systemic antibiotics.Sales data from community pharmacies are important for accurate estimation of systemic antibiotic use in Emilia-Romagna especially for agents, such as nitrofurantoin, purchased without reimbursement in most cases.