# Antibiotic Use in the Community in Spain: A National Surveillance System Within the Framework of the Spanish Action Plan on Antimicrobial Resistance

## TL;DR

This study shows that Spain's BIFAP database can effectively monitor antibiotic use in the community, revealing patterns and supporting efforts to reduce inappropriate prescriptions.

## Contribution

The study validates BIFAP as a reliable data source for national antimicrobial prescribing surveillance in Spain.

## Key findings

- 23.3% of the population received at least one antibiotic prescription in 2018.
- First-line recommended antibiotics accounted for 26.5% of total dispensed defined daily doses.
- Older adults were more likely to receive broad-spectrum antibiotics compared to children.

## Abstract

Background: Antimicrobial resistance (AMR) remains a critical major public health challenge, largely driven by the inappropriate use of antibiotics in the community. In Spain, the National Action Plan on AMR (PRAN) emphasizes the need for robust surveillance systems based on standardized indicators and high-quality data sources. Objective: This study aimed to evaluate the feasibility of calculating PRAN prescribing indicators using the National Electronic Database for Pharmacoepidemiological Research in Primary Care (BIFAP) and to validate BIFAP as a data source for national antimicrobial prescribing surveillance. Methods: A population-based cross-sectional study was conducted using 2018 data from 9.4 million individuals. Results: Overall, 23.3% received at least one antibiotic prescription during the year, with an average of 1.8 treatments per patient. First-line recommended antibiotics represented 26.5% of total dispensed defined daily doses. Notable age-related variability in prescribing patterns was observed: children predominantly received first-line narrow-spectrum antibiotics, whereas older adults were more frequently prescribed broad-spectrum agents. Discusion: BIFAP-based indicators closely aligned with PRAN data while allowing for the calculation of additional metrics, such as prevalence of use, treatments per patient-year, and variations by age and sex. The findings underscore the importance of patient-level monitoring to identify demographic-age-specific priorities for targeted interventions aimed at optimizing antibiotic use in Primary Care. Conclusions: This study confirms the feasibility of using BIFAP to strengthen antibiotic consumption monitoring and policy evaluation efforts in Spain.