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Introduction Consumption of antibiotics is high in Spain, primarily in children. Excessive use of then contributes to the development of antimicrobial resistance. The aim of our study is to analyse the evolution of antibiotic consumption at the Primary Health Care in the paediatric population of Asturias, Spain, from 2014 to 2021, and to evaluate the impact of COVID-19 pandemic on it.Methods Retrospective and observational study using data about antibacterial agents for systemic use dispensed for official prescriptions to children under 14 years in Primary Care. Antibiotic consumption is expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID).Results The antibiotic consumption rate dropped from 13.9 DID in 2014 to 4.0 in 2021 (β = -1,42, p=0,002), with and inflection point in 2019. From 2019 to 2020 antibiotic use dropped by 47.1%. Antibiotic consumption remained very low from April 2020 to September 2021, and then moderately increased from October 2021. Prevalence of antibiotic use dropped from 39.9% in 2014 to 17.5% in 2021 (β = -3,64, p=0,006). Relative consumption of amoxicillin/clavulanic acid decreased, while those of amoxiciline and third-generation cephalosporins increased.Conclusions Paediatric antibiotic consumption collapsed in Asturias in 2020, coinciding with COVID-19 pandemic. Monitoring of antimicrobial usage indicators will allow to check if these changes are sustained over time.

Objetivo Estudiar la evolución del consumo de antibióticos en población adulta en el ámbito de Atención Primaria (AP) del Servicio de Salud del Principado de Asturias (SESPA) durante 2014-2020. Diseño Estudio observacional retrospectivo. Emplazamiento AP del SESPA. Participantes Población de la base de datos de Tarjeta Sanitaria Individual. Intervenciones Se recogieron datos de prescripción de antibióticos, realizada en las consultas de medicina de familia, dispensados en las oficinas de farmacia con cargo al SESPA. Se analizaron variables de uso y consumo de antibióticos mediante modelos de regresión lineal. Mediciones principales Prevalencia de uso de antibióticos (porcentaje población); tasa de consumo de antibióticos de uso sistémico (DTD), consumo relativo de antibióticos de espectro reducido (porcentaje DDD). Resultados La prevalencia media del uso de antibióticos del periodo 2014-2019 fue de 32,2% y 23,9% en 2020. La tasa de consumo de antibióticos de uso sistémico pasó de 21,4 DTD en 2014 a 12,7 DTD en 2020. El consumo de antibióticos de espectro reducido se mantuvo estable (19,4% DDD en 2014 y 19,3% DDD en 2020) (IC95: -0,10, 0,26). En el periodo de marzo a diciembre de 2020, el consumo de antibióticos se redujo un 28,6% respecto al mismo periodo de 2019. Conclusiones En 2014-2020 el consumo de antibióticos disminuyó, especialmente a partir de la pandemia por COVID-19, con estabilización del consumo de antibióticos de espectro reducido respecto al total. Existe variabilidad en el consumo por subgrupos terapéuticos.

Resumen Objetivo Analizar los criterios STOPP/START encontrados con mas frecuencia en los estudios llevados a cabo en Espana, con el fin de identificar las areas principales de prescripcion potencialmente inadecuada. Metodos Revision de la literatura de los estudios originales realizados en Espana que aplicaron los criterios STOPP/START, version 2008, y que describian los criterios STOPP o START mas comunes. En cada estudio, se realizo un analisis ponderado de los criterios encontrados, asignando una puntuacion 5 al criterio encontrado en la primera posicion, 4 al criterio en segunda posicion y asi sucesivamente hasta el quinto criterio. Posteriormente se obtuvieron las puntuaciones totales para cada criterio analizado. Resultados Se seleccionaron 19 estudios originales que analizaban los criterios STOPP, de los cuales 14 analizaban tambien todos los criterios START. Del total de estudios, 11 se desarrollaron en atencion extrahospitalaria y 8 en atencion hospitalaria. El criterio STOPP con la valoracion ponderada mas alta fue el B7 (uso prolongado de benzodiacepinas de vida media larga), seguido del J (cualquier prescripcion regular de 2 farmacos de la misma clase). El criterio START con la valoracion ponderada mas alta fue el F4 (estatinas en la diabetes mellitus si coexisten uno o mas factores mayores de riesgo cardiovascular), seguido del E3 (suplementos de calcio y vitamina D en pacientes con osteoporosis conocida [con evidencia radiologica o fractura por fragilidad previa o cifosis dorsal adquirida]). Conclusiones Las areas de prescripcion potencialmente inadecuada estan bien definidas y sanalan la pertinencia de intervencion en algunos puntos terapeuticos concretos.

Resumen: Objetivo: Evaluar si la crisis económica de 2008 ha comportado cambios en la evolución del consumo de ansiolíticos, hipnótico-sedantes y antidepresivos en Asturias. Método: Estudio descriptivo y de utilización de medicamentos durante 2003-2013. Se calcularon las dosis diarias definidas por 1000 habitantes/día (DHD) de ansiolíticos, hipnótico-sedantes y antidepresivos. Se obtuvieron coeficientes de regresión lineal (b) de las DHD de la etapa precrisis (2003-2008) y de la etapa de crisis (2009-2013). Resultados: El consumo de ansiolíticos creció un 40,25%, el de hipnóticos un 88,11% y el de antidepresivos un 80,93%. Para los ansiolíticos: b-(2003-2008) = 4,38 DHD/año y b-(2009-2013) = 1,08 DHD/año. Para los hipnótico-sedantes: b-(2003-2008) = 2,30 DHD/año y b-(2009-2013) = 0,40 DHD/año. Para los antidepresivos: b-(2003-2008) = 5,79 DHD/año y b-(2009-2013) = 2,83 DHD/año. Conclusiones: El incremento del consumo para los tres subgrupos en la época de crisis fue menor que en la época precrisis. No se confirma que la crisis económica haya influido aumentando el consumo de estos medicamentos. Abstract: Objective: To assess whether the economic crisis of 2008 has changed the consumption of anxiolytics, hypnotics-sedatives and antidepressants in Asturias (Spain). Method: We conducted a descriptive study of drug use from 2003 -2013. The defined daily doses of 1000 inhabitants per day (DHD) were calculated for anxiolytics, hypnotics-sedatives and antidepressants. Linear regression coefficients (b) of the DHD were obtained for the pre-crisis period (2003-2008) and the crisis period (2009-2013). Results: The consumption of anxiolytics increased by 40.25%, that of hypnotics by 88.11% and that of antidepressants by 80.93%. For anxiolytics: b-(2003-2008) = 4.38 DDI/year and b-(2009-2013) = 1.08 DDI/year. For hypnotics-sedatives: b-(2003-2008) = 2.30 DDI/year and b-(2009-2013) = 0.40 DDI/year. For antidepressants: b-(2003-2008) = 5.79 DDI/year and b-(2009-2013) = 2.83 DDI/year. Conclusions: The rise in consumption of the three subgroups during the crisis period was lower than that of the pre-crisis period. This study does not confirm the influence of the economic crisis on the rise in consumption of these drugs. Palabras clave: Ansiolíticos, Hipnóticos y sedantes, Antidepresivos, Recesión económica, Keywords: Anxiolytics, Hypnotics and sedatives, Antidepressants, Economic recession

Objective To assess potentially inappropriate medications (PIMs) in elderly outpatients taking multiple medications. Methods Invoicing data of the prescriptions and electronic medical records were used to apply the STOPP (screening tool of older people's prescriptions) criteria. Results Three out of 4 patients included in the study received PIMs. The most common criteria found were: duplicate drug class prescriptions (n = 58 (17.4%)), long-term long-acting benzodiazepines (n = 54 (16.2%)), and acetylsalicylic acid with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (n = 32 (9.6%)). Conclusion Our results highlight the relevance of the systematic review of the pharmacological treatments in these patients.

ResumenDentro del protocolo de pacientes polimedicados/as elaborado por el Servicio de Salud del Principado de Asturias, los/las médicos/as de atención primaria reciben periódicamente los listados de los tratamientos de pacientes de cualquier edad que consumen 10 o más medicamentos/día durante un período de 6 meses. Actualmente, el Servicio de Salud del Principado de Asturias está desarrollando un proyecto orientado a evaluar las medicaciones de pacientes polimedicados/as, con el fin de identificar: 1) el consumo de medicamentos de utilidad terapéutica baja, 2) el consumo de fármacos potencialmente nefrotóxicos en pacientes con filtrado glomerular disminuido, y 3) la posible prescripción inadecuada en pacientes mayores de 65 años. El proyecto se inició con una primera fase llevada a cabo en el Área Sanitaria II y actualmente se pretende extenderlo a las áreas sanitarias restantes. Consideramos que su automatización y aplicación generalizada podrían ser útiles para optimizar la prescripción de medicamentos.AbstractAs part of the protocol of the Health Service of the Principality of Asturias (Spain), primary care physicians periodically receive listings of the treatments of patients of any age taking 10 or more drugs/day for 6 months. Currently, the Health Service of the Principality of Asturias is developing a project that aims to assess the medications of polypharmacy patients. The aim is to identify: 1) the consumption of medicines of low therapeutic usefulness, 2) the consumption of potentially nephrotoxic drugs in patients with a low glomerular filtration rate, and 3) potentially inappropriate prescribing in patients aged 65 years or older. The project was started in Health Area II and the aim is to extend it to the remaining health areas. In our opinion, its automation and general implementation could be useful to optimize drug prescription.

Objective To analyze potentially inappropriate prescribing (PIP) using the 2014 version of STOPP criteria. Materials and methods Prescriptions were analyzed by using invoicing data and electronic medical records. Results At least one STOPP criterion was observed in 9 out of every 10 patients. The most common STOPP criteria found were: "any drug prescribed without an evidence-based clinical indication" and "any drug prescribed beyond the recommended duration, where treatment duration is well defined". Conclusion The high prevalence of PIP found seems to be due to the inclusion of new criteria related to indication of medication and duration of treatments. .

To analyse STOPP/START criteria found most frequently in the studies carried out in Spain, in order to identify the main areas of potentially inappropriate prescribing.A literature review was carried out on the original studies performed in Spain that applied the original version of the STOPP/START criteria and that described the most common STOPP and/or START criteria found. In each study, a weighted analysis was performed on the criteria found, by assigning 5 points to the criterion in first position, 4 points to the criterion in second position, and so on to fifth criterion. The total points of each analysed criterion were then obtained.A total of 19 original studies analysing STOPP criteria were selected, 14 of them also studying all START criteria. From the total of studies, 11 were developed in out-of-hospital care, and 8 in hospital care. The STOPP criterion with the highest weighted assessment was B7 (long-term, long-acting benzodiazepines), followed by J (any duplicate drug class prescription). The START criterion with the highest weighted assessment was F4 (statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present), followed by E3 (calcium and vitamin D supplement in patients with known osteoporosis: previous fragility fracture, acquired dorsal kyphosis).The most common areas of potentially inappropriate prescribing are well defined, and suggest a particular intervention in some specific therapeutic points.

As part of the protocol of the Health Service of the Principality of Asturias (Spain), primary care physicians periodically receive listings of the treatments of patients of any age taking 10 or more drugs/day for 6 months. Currently, the Health Service of the Principality of Asturias is developing a project that aims to assess the medications of polypharmacy patients. The aim is to identify: 1) the consumption of medicines of low therapeutic usefulness, 2) the consumption of potentially nephrotoxic drugs in patients with a low glomerular filtration rate, and 3) potentially inappropriate prescribing in patients aged 65 years or older. The project was started in Health Area II and the aim is to extend it to the remaining health areas. In our opinion, its automation and general implementation could be useful to optimize drug prescription.