Ongoing initiatives in Azerbaijan to improve the use of antibiotics; findings and implications

Background: There have been a numerous initiatives in Azerbiajan in recent years to improve antibiotic utilization including educational programmes among patients, pharmacists and physicians. Consequently, this study aimed to analyse the influence of these multiple initiatives on antibiotic utilization as a basis for suggesting future initiatives. Methods: Observational retrospective study of total antibiotic utilization from 2011 to 2015 based on import data. The quality of aggregated antibiotic prescribing was assessed against recognised indicators including those of WHO Europe, as well as compared to neighbouring countries as reference points. Results: There was a significant reduction in total antibiotic utilization from 17.1 DIDs in 2011 in Azerbaijan to 8.02 DIDs in 2015, the lowest level compared with similar countries. Beta lactam antibiotics were typically the largest group of antibiotics with low overall use of co-amoxiclav (although relative utilisation rising), macrolides, cephalosporins and fluoroquinolones. There are concerns with rising use of tetracyclines in recent years in place of penicillins with changing pricing policies, as well as high relative use of third generation cephalosporins. Conclusions: Multiple interventions in Azerbaijan in recent years appear to have resulted in low use of antibiotics when compared with similar countries. However, there are some concerns especially with third generation cephalosporins. There needs to be a closer look at indications to further improve antibiotic use.