Objective(s): Antibiotic utilization studies based on national macro data are crucial for identifying indicators of irrational use. Despite numerous scattered center-level studies regarding antibiotic use in our country, no comprehensive national-level report on the prescribing of antibiotics based on claim data has yet been published. Furthermore, in terms of indices and comprehensiveness, the findings of previous studies were not comparable with the international studies. This study aimed to investigate the prescribing pattern and utilization of antibacterial drugs in Iran using Iranian Health Insurance claims data from 2014 to 2019.
Methods: Patient-level data of prescribed systemic antibacterial drugs (J01 group in the World Health Organization's (WHO) Anatomical Therapeutic Chemical (ATC) classification 2020) were extracted from the Iranian Health Insurance Organization (IHIO) from 2014 to 2019. We investigated prescribing frequencies (percentages from annual use, rate per 1,000 beneficiaries), patterns (drug utilization 90% and share of WHO Access, Watch, Reserve (AWaRe) categories), and consumption (WHO-defined daily doses (DDD)/1,000 beneficiaries per day (DID)).
Results: Antibiotic consumption (DID) in prescriptions of the IHIO plan for government employees was 26.8 and 24.1 in 2014 and 2019, respectively. Cefixime and azithromycin accounted for about 50% of the total antibiotics prescribed annually in IHIO.  The Watch category antibiotics accounted for 54.5% and 57.8% of the annual consumption in 2014 and 2019, respectively. General physicians were responsible for more than half of the antibiotics prescribed throughout the study years. The proportion of the Watch category in the prescribed antibiotics by general physicians increased from 41% in 2014 to 48% in 2019. Zanjan, Yazd, Kerman, Fars, Markazi, Sistan and Balouchestan, and East Azerbaijan were the provinces with the highest frequency of the Watch category antibiotics.
Conclusion: Despite the relative decrease in the frequency and amount of antibiotics prescribed in the IHIO, the increase and share of Watch antibiotics is alarming and should ring bells for policymakers.