3. IMPACT OF REGULATORY MEASURES ON ANTIBIOTIC SALES IN CHILE. Bavestrello L, Cabello A. Gustavo Fricke Hospital.Viña del Mar.CHILE

4. Introduction  Antibiotics are drugs used in the prevention and treatment of infections caused by pathogenus microorganisms.  Its use must be linked to a medical prescription since they can present adverse reactions and its use is related to an increase of bacterial resistance.  There is a relationship between antibiotic consumption in the community and the appearance and spreading of resistance.

5. Introduction  Therefore, the indiscriminate use of antibiotics increases the appearance of bacterial resistence and forces the use of more expensive alternatives.  A previous study done by us in 1998, about the ten years tendency in antibiotics consumption, showed a large increase between 1988 and 1997.This study and many meetings with several organizations created the intervention possibility.

6. Introduction  After that, the Chilean Ministry of Health decided an intervention to regulate the consumption of antibiotics since September 1999, as a strategy to encourage the rational use of antibiotics.

7. OBJECTIVE  To study the impact of the 1999 regulatory measures on antibiotic sales implemented by the Chilean Ministry of Health in community pharmacies.This study was carried out in three ways: -in DDD/1000 inh-day as a consumption unit -in sale units -In money, expressed in USD during seven years, from 1996 to 2002.

8. METHOD 1) Definition of the consumption unit used: DDD/1000 inhabitants-day a)Census population data of Chile. b)Annual sales data for antibiotics. I.M.S. 1996 to 2002. 2) Calculation of the Nº of DDD sold for each antibiotic: DDD/1000 inhabitants/day = sold grams x 1000 DDD spe.x Nºdays x Population

9. Intervention: In order to obtain the intervention decision, we participated in many meetings with organizations related with public health like: Chilean Infectious Disease Society Chilean Microbiology Society Chilean Pharmacology Society Public Health Institute Professional organizations of Physicians and Pharmacist National Congress Health Committee National Department of Consumers.

10. The basis of action Plan to assure antibiotics rational use  The antibiotic use must respond to a diagnosis and medical prescription.  The dispense of the antibiotics must take place in the presence of a prescription.  The condition of sale written in the package of each antibiotic pharmaceutical product must be executed in all circunstance and at any moment.(Document 4C/4619, September 1999)

11. Contents of the action plan:  To achieve the antibiotic sale restriction (sale only with prescription).  Population Information: leaflets and posters in community pharmacies.  Extensive coverage on radio, television and newspaper.  Educational campaign.  Test the compliance of the sale restriction.

13. Results  There was an important reduction in consumption, expressed as DDD/1000 inh.- day, after the introduction of the regulatory measures for the most oral antibiotic groups.  After 1999, there was also an important fall in sale units and also in sales expressed in US dollars.  This tendency is mainteined during the last 3 years.

14. This is where a large graphic or chart can go.

15. Graph 2:Units of packages sold from 1988 to 2002.

16. Graph 3:Units of packages sold from 1988 to 2002.

17. Year 1996199719981999200020012002 USD 37,645,8 38,932,129,426,1 Table 1:Sales of oral antibiotics in USD.(Mill$) - 15% - 30% - 36% - 43%

18. CONCLUSIONS The regulatory measures in 1999 had an important impact in the community antibiotic consumption in Chile. The regulatory measures contributed to a considerable saving of money in the community due to a decrease in antibiotic use. The success of the long term program depends on the compliance, maintenance, supervision and control of these measures by involved parts, including physicians, prescriptors, pharmacist and community in general.