Key points
-
Individuals residing in rural areas in the Netherlands used more antibiotics, especially young people < 45 years of age.
-
Adults in rural areas were more likely to require a second course of antibiotics within 14 days after starting the first course.
-
The findings of this study might result from greater exposure to resistant bacteria that originate from cattle farms.
Background
Methods
The IADB.nl database
Degree of urbanization
Analysis of the number of prescriptions and types of antibiotics
Therapeutic failure
Statistical analysis
Results
Rural (DU = 5) | Urban (DU = 1) | p* | |
---|---|---|---|
Number of prescriptions
| 141 866 | 569 946 | |
(1998-2009) | (1998-2009) | ||
Number of patients in the population (2009)
| 37 896 | 140 726 | |
Age distribution of patients (2009)
| |||
0-19 years
| 23.5% (8,918) | 15.7% (22,132) | <0.001 |
20-45 years
| 30.3% (11,500) | 51.9% (73,169) | <0.001 |
46-70 years
| 36.9% (13,997) | 23.5% (33,271) | <0.001 |
71 years or older
| 9.2% (3,481) | 8.8% (12,414) | 0.028 |
Males in the population (2009)
| 50,2% (19,033) | 47,6% (67,106) | <0.001 |
Year/age group | 1999 | 2004 | 2009 | ||||||
---|---|---|---|---|---|---|---|---|---|
Rural | Urban | p* | Rural | Urban | p | Rural | Urban | p | |
Total
|
24.8
|
20.2
|
<0.001
|
22.4
|
19.8
|
<0.001
|
23.6
|
20.2
|
<0.001
|
0-19 years
|
23.9
|
18.6
|
<0.001
|
20.6
|
18.1
|
<0.001
|
19.3
|
17.4
|
<0.001
|
20-45 years
|
23.0
|
15.9
|
<0.001
|
20.3
|
15.8
|
<0.001
|
22.6
|
16.1
|
<0.001
|
46-70 years
| 25.3 | 24.8 | 0.413 |
23.2
|
22.7
|
<0.001
| 23.5 | 23.4 | 0.9822 |
71 and older
|
38.1
|
33.7
|
<0.001
|
34.0
|
36.5
|
0.015
|
36.6
|
41.9
|
<0.001
|
male
|
21.2
|
16.1
|
<0.001
|
19.1
|
15.3
|
<0.001
|
19.7
|
15.7
|
<0.001
|
female
|
28.5
|
23.7
|
<0.001
|
25.5
|
23.5
|
<0.001
|
27.6
|
24.2
|
<0.001
|
Year/age group | 1999 | 2004 | 2009 | ||||||
---|---|---|---|---|---|---|---|---|---|
Rural | Urban | p*1
| Rural | Urban | p | Rural | Urban | p | |
Total
| 1.70 | 1.71 | 0.400 | 1.72 | 1.76 | 0.525 |
1.80
|
1.82
|
<0.001
|
0-19 years
|
1.64
|
1.47
|
<0.001
|
1.58
|
1.50
|
0.002
|
1.55
|
1.47
|
<0.001
|
20-45 years
|
1.55
|
1.49
|
0.003
|
1.56
|
1.50
|
0.001
|
1.57
|
1.47
|
<0.001
|
46-70 years
| 1.72 | 1.80 | 0.129 |
1.75
|
1.83
|
0.008
| 1.79 | 1.81 | 0.802 |
71 and older
| 2.28 | 2.22 | 0.606 |
2.29
|
2.44
|
0.047
| 2.66 | 2.84 | 0.533 |
male
| 1.60 | 1.63 | 0.332 | 1.62 | 1.66 | 0.329 |
1.65
|
1.63
|
0.019
|
female
|
1.77
|
1.76
|
0.022
| 1.79 | 1.83 | 0.582 |
1.91
*2
|
1.91
|
<0.001
|
Rural (n = 183 947) | % | Urban (n = 626 584) | % | P* | |
---|---|---|---|---|---|
J01A (tetracyclins)
| 42 604 | 23.16 | 13 4594 | 21.48 | <0.001 |
J01B (amfenicoles)
| 3 | 0.002 | 9 | 0.001 | 0.877 |
J01C (penicillins)
| 71 644 | 38.95 | 20 1984 | 32.24 | <0.001 |
J01D(cephalosporins)
| 1012 | 0.55 | 4520 | 0.72 | <0.001 |
J01E (sulfonamide/trimethoprim)
| 20 025 | 10.89 | 88 906 | 14.19 | <0.001 |
J01F (macrolids)
| 22 025 | 11.97 | 67 981 | 10.85 | <0.001 |
J01G (aminoglycosids)
| 323 | 0.18 | 510 | 0.08 | <0.001 |
J01M (fluorochinolons)
| 10 163 | 5.52 | 53 375 | 8.52 | <0.001 |
J01X (miscellaneous)
| 16 148 | 8.79 | 74 705 | 11.92 | <0.001 |
1999-2005 | |||||
---|---|---|---|---|---|
Rural | Urban | ||||
Age | Nr new antibiotic | Total nr patients | Nr new antibiotic | Total nr patients | Relative risk (Confidence intervals) |
In 14 days | In 14 days | ||||
0-19 | 1902 | 23 955 | 3733 | 49 128 | 1.04 (0.99-1.10) |
20-40
|
2409
|
25 152
|
11 426
|
127 056
|
1.06 (1.02-1.11)
|
41-60
|
3863
|
33 452
|
8591
|
83 736
|
1.12 (1.09-1.17)
|
60-80
|
3435
|
24 994
|
11 014
|
87 526
|
1.09 (1.05-1.13)
|
Total
|
11609
|
107553
|
34764
|
347446
|
1.08 (1.06-1.10)
|