OBJECTIVES: To analyse drug prescription and patterns of antibiotic use by sex and age in Italy’s Campania Region estimating distribution of prevalence prescription’s rate in Children (≤ 14), Adults (15≥ <65) and Elderly (≥65) at municipality level.

METHODS: Retrospective analysis of pharmacy records in Campania Region in 2016. Prevalence was used to estimate the degree of exposure to antibiotic prescription (ATC-code ‘J01’). Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient’s municipality of residence. The relation between children, adults and elderly prevalence rates was estimated by non-parametric Spearman rank correlation test.

RESULTS: The overall antibiotic prevalence rate was 46.8%. Antibiotic consumption was higher for children <5 years (highest value 60.7%) and for elderly >70 years (highest value 80.3%). Distribution of prevalence differed among municipalities for all age groups. Higher rates in children were observed in coastal areas around Naples, northern Caserta and eastern Avellino (50.2%- 68.0%). The same areas showed very high prevalence rates both for adults and elderly (46.3- 59.5; 71.0%-89.5%, respectively). A positive correlation between the rank distribution of prevalence rates at municipality level was found in children and adults (rs=0.56; r<0.01); in adults and in elderly (rs=0.79; r<0.01); in children and in elderly (rs=0.46; r<0.01). Penicillin was the most prescribed antibiotics class in all age groups save among the elderly >85 years, (45% in children; 27.2% in elderly). Quinolones showed an opposite trend: less prescribed antibiotic class in children group (0.2%) and then gradually increasing to 30.2% in the elderly.

CONCLUSIONS: Antibiotic use in Campania is much higher than in other regions and countries. Wide local differences for all age groups were found at municipality level. Moreover, the use of second-line antibiotics is common. To decrease prescriptions and improve appropriateness, active training and timely feed-back to physicians, focused at the territorial level, is recommended.