Introduction: There are increasing concerns world-wide with growing rates of antibiotic
resistance necessitating urgent action. There have been a number of initiatives in the
Republic of Srpska in recent years to address this and improve rational antibiotic
prescribing and dispensing despite limited resources to fund multiple initiatives.
Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following
these multiple initiatives as a basis for developing future programmes in the Republic if
needed.
Methods: Observational retrospective study of total outpatient antibiotic utilization
from 2010 to 2015, based on data obtained from the Public Health Institute, alongside
documentation of ongoing initiatives to influence utilization. The quality of antibiotic
utilization principally assessed according to ESAC, ECDC, and WHO quality indicators
and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries.
Results: Following multiple initiatives, antibiotic utilization remained relatively stable
in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with
rates comparable or lower than neighboring countries. Amoxicillin and the penicillins
accounted for 29–40 and 50% of total utilization, respectively. Overall, limited utilization
of co-amoxiclav (7–11%), cephalosporins, macrolides, and quinolones, as well as low
use of third and fourth generation cephalosporins vs. first and second cephalosporins.
However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates
of quinolone utilization compared to some countries, was seen.
Conclusions: Multiple interventions in the Republic of Srpska in recent years have
resulted in one of the lowest utilization of antibiotics when compared with similar
Bojanic et al. ´ Antibiotics in Republic of Srpska
countries, acting as an exemplar to others. However, there are some concerns with
current utilization of co-amoxiclav and azithromycin which are being addressed. This
will be the subject of future research activities.
