on line editionOutpatient use of antibiotics in children in Slovenia
Original Scientific article
idZdrav Vestn | May – June 2017 | Volume 86 Microbiology and immunologyOriginal scientific article
1 Department of 
Infectious Diseases 
and Febrile Illnesses, 
University Medical Centre 
Ljubljana, Ljubljana
2 ESAC – Net (European 
Surveillance of Antibiotic 
Consumption – Net)
3 National Institute for 
Public Health, Ljubljana
4 Barsos MC, Ljubljana
5 TOMTIM d.o.o., 
Ljubljana
Correspondence:
tina Plankar Srovin,  
e: tinaplans@gmail.com
Key words:
antibiotics; children; 
outpatient use; decrease 
of consumption
Cite as:
Zdrav Vestn. 2017;  
86:185–94.
received: 14. 12. 2016 
accepted: 8. 3. 2017
Outpatient use of antibiotics in children in 
Slovenia
Milan Čižman,1,2 tina Plankar Srovin,1 Maja Sočan,3 aleš Korošec,2,3 Jerneja ahčan,4  
tom Bajec2,5
Abstract
Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is 
estimated that up to 50 % of antibiotic prescriptions are unnecessary or inappropriate. To plan the 
actions to optimize the use of antibiotics we conducted a national antibiotic consumption study in 
children aged 0–18 years in the period between 2003 and 2015.
Methods: In this national retrospective research we analyzed outpatient antibiotic consumption us-
ing the ATC/DDD classification. The data on antibiotic use were ?stratified ali analyzed by the pat-
tern of prescription, age, gender and health region.
Results: The total consumption of antibiotics during the study period decreased by 35 %, from 979 to 
636 prescriptions per 1000 children/year (PTY),. The use of all antibiotic classes decreased (except 
for quinolones and nitrofuran derivatives) from 12.5 % to 81 %. Over the study period we found the 
highest consumption in children from 1 to 4 years (2184–1160 PTY). Amoxicillin was the most com-
monly prescribed antibiotic in children aged 0 to 4 years, penicillin V among those aged 5 to 14 years, 
and co-amoxiclav among adolescents aged 15 to 19 years. In northeastern health regions of Slovenia 
much more antibiotics were prescribed than in other regions. In 2015, 65 % of prescriptions were pre-
scribed by paediatricians and school medicine specialists, 16 % by physicians without specialization, 
14 % by GP/family doctors and 5 % by other specialists.
Conclusions: Despite the decrease in outpatient antibiotic use in children and adolescents in Slove-
nia, the overall and especially broad-spectrum antibiotic consumption (amoxicillin with clavulanic 
acid, azithromycin and second/third generation cephalosporins) is still too high. It is necessary to 
strengthen the activities to reduce prescribing, particularly for acute (upper) respiratory tract infec-
tions.
Cite as: Zdrav Vestn. 2017; 86:185–94.
1. Introduction
Antibiotics are the most common 
prescription drugs given to children 
with the highest incidence rates in pre-
schools.(1,2) There are large variations in 
antibiotic prescribing among countries 
and also within them.(3,4) Prescribing 
antibiotics to children < 19 years varies 
between less than 300 and over 1500 pre-
scriptions per 1000 children/year (PTY) 
(Table 1) (1,5,6).
Antibiotic prescribing varies across 
paediatric practices in overall antibiotic 
prescribing rates and also in broad-spec-
trum antibiotic prescribing (7). Primary 
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MicrOBiOlOgy and iMMunOlOgy
paediatric care in Europe is provided 
by paediatricians or family doctors and 
general practitioners or both, and varies 
among countries as well (8). Acute respi-
ratory tract infections followed by skin/
cutaneous/mucosal and urinary tract 
infections are the most common condi-
tions contributing to antibiotic prescrib-
ing in the ambulatory paediatrics (9).
To plan relevant activities that would 
limit ali reduce the overuse of antibiotics 
of the total as well as of particular classes 
of antibiotics we conducted a retrospec-
tive national antibiotic consumption 
study in children aged 0–18 years in the 
period 2003–2015 characterising the pat-
terns of antibiotic prescribing in relation 
to age, gender, health region, incidence 
of common infections and prescribers.
2. Methods
Slovenia is a small central European 
country with 2,064,188 inhabitants ac-
cording to the January 2016 census 
data  (10). It has 9 health regions with 
the populationsvarying from 71,218 to 
656,831 (11). For the period 2003–2015 the 
data on outpatient antibiotic consump-
tion were analysed using the Anatomical 
Therapeutic Chemical classification with 
defined daily doses (ATC/DDD); WHO 
2016. The results were expressed in DDD 
per 1000 inhabitants per day (DID) and 
PTY  (12). The same definition of DDD 
was used for children and adults. The 
number of prescriptions of antibiotic for 
systemic use (JO1) and the incidence of 
infections were provided by the National 
Institute of Public Health (NIPH) of the 
Republic of Slovenia. The data on antibi-
otic consumption were analyzed by age, 
gender and health region. The analysis 
was retrospective and included the en-
tire country. We did not need an approv-
al from the Medical Ethics Committee.
3. Results
3.1. Total antibiotic consumption 
and pattern of consumption
The overall antibiotic consumption 
and its pattern during 2003–2015 ex-
pressed as PTY are shown in Table 2.
The consumption, expressed as PTY, 
decreased by 35 %; whenexpressed as 
DID it decreased by 26.5 % (from 17.92 to 
13.18 DID).
During the study period there was a 
steady decrease with small temporary 
increases in different years. The use of all 
antibiotic classes decreased, except for 
nitrofuran derivatives (nitrofurantoin), 
polymyxins and quinolones. The highest 
decrease was seen in cephalosporin of 
3rd and 2nd generations (by about 80 %), 
followed by macrolides and co-trimoxa-
zole (60 %) and antistaphylococcal peni-
cillins (57 %).
3.2. Prescriptions 
according to gender
In 2015 the amount of antibiotics pre-
scribed to girls was by 5.6 % higher than 
Table 1: Outpatient antibiotic prescribing rates (number of prescriptions per 
100 children per year) in some european countries. (1,5,6).
Country Year Age (years) PTY
Serbia 2013 0–18 1365
greece 2010–13 0–18 1100
italy (emilia-romagna) 2008 0–18 957
Slovenia 2015 0–18 636
germany 2008 0–18 561
united Kingdom 2008 0–18 555
denmark 2008 0–18 481
Sweden 2010 0–18 300
the netherlands 2008 0–18 294
Legend: PTY – number of prescriptions per 1000 children per year.
on line editionOutpatient use of antibiotics in children in Slovenia
Original Scientific article
that prescribed to boys (654 vs. 619 PTY). 
Macrolides, lincosamides, cephalospo-
rins, quinolones, TMP/SMX, other anti-
biotics and aminoglycosides were more 
commonly prescribed to girls than boys.
3.3. Incidence of outpatient 
infections in children and 
adolescent (0–19 years)
The incidence rate and trend of spe-
cific diagnoses listed in the ICD-10 in the 
years 2005 and 2015 are shown in Table 
3. Acute viral respiratory tract infections 
were the most common infections in 
both years, followed by upper respirato-
ry tract infections (URTI), lower respira-
tory tract infections, skin and soft tissue 
infections and urinary tract infections.
3.4. Total consumption and pattern 
of consumption by age groups
Table 4 shows the prescriptions of an-
tibiotics for systemic use per 1000 chil-
dren/adolescents by age groups in 2015.
In the study period the highest inci-
dence rate of antibiotic use was observed 
among children 1 to 4 years (2184–1160), 
followed by children 5 to 9 years (1203–
723), then in children < 1 year (482–456 ), 
followed by children 15 to 19 years (566–
398), and 10 to 14 years (602–350).
Amoxicillin was the most commonly 
prescribed antibiotic in children aged 
0–4 years, penicillin V among those aged 
5 to 14 years and co-amoxiclav among 
adolescents aged 15 to 19 years (Table 4).
Table 2: number of prescriptions per 1000 children per year in 2003 and 2015 in Slovenia.
ATC 
code
ATC name 2003 2015 2003 vs. 
2015
J01 a tetracyclineS 5 4 - 20
J01 c Beta-lactaM antiBacterialS, 
PenicillinS
657 515 - 21.7
ca
ce
cf
cr
Penicillin with extended spectrum
Beta-lactamase sensitive penicillins
Beta-lactamase resistant penicillins
combination of penicillins and beta-
lactamase inhibitors
270
216
7
164
222
167
3
123
-17.8–22.7–
57–25
J01 d
dB
dc
dd
OtHer Beta-lactaM antiBacterialS
first-generation cephalosporin
Second-generation cephalosporin
third-generation cephalosporin
86
2
79
5
17
1
15
1
- 80.2–50–
81–80
J01 e SulPHOnaMid and triMetHOPriM 58 23 - 60.3
J01 f
fa
ff
MacrOlideS and lincOSaMideS
Macrolides
lincosamides
170
166
4.0
71
67
3.5
- 58.3–59.6–
12.5
J01 M
Ma
QuinOlOne antiBacterialS
fluoroquinolones
3
3.22
3
3.27
+1.5
J01 X
XB
Xe
OtHer antiBacterialS
Polymyxins
nitrofuran derivatives
-
-
3
0
3
Total 979 636 - 35
Legend: ATC, J01 – antibacterials for systemic use
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MicrOBiOlOgy and iMMunOlOgy
3.5. Prescriptions by regions
Regional differences in incidence 
rates of treatment episodes within age 
group 0–18 years were identified. In the 
year 2015 there was an 83 % difference 
between the regions with the lowest and 
the highest total antibiotic consumption. 
The highest consumption was observed 
in the health region of Murska Sobota, 
in the northeast of Slovenia, and the 
lowest in the region of Nova Gorica, the 
westernmost part of the country (925 vs. 
506 PTY). The median consumption was 
688, and the average consumption 668 
PTY.
3.6. Prescriptions by speciality
The differences in antibiotic prescrip-
tions by different specialists were iden-
tified (Table 5). Amoxicillin was pre-
scribed most commonly by all specialists 
followed by penicillin. It is a matter of 
concern that physicians without special-
ization prescribed substantially more 
frequently co-amoxiclav. Paediatricians 
prescribed cephalosporins more often 
than other specialists did.
4. Discussion
In Slovenia, the total number of pre-
scriptions for systemic use in children 
and in adolescents decreased by 35 %, 
and the consumption of different classes 
of antibiotics except for quinolones and 
nitrofuran derivatives from 12.5 %to 81 % 
during the period from 2003 to 2015 
(Table 2). The decrease in the total an-
tibiotic consumption is favourable but 
too small. When we benchmark the data 
with other countries we can see that in 
some countries (The Netherlands, Swe-
den), prescribe substantially fewer anti-
biotics (300 PTY vs. 636) are prescribed 
(Table 1). In both cited countries prima-
ry paediatric care is provided by family 
Table 3: causes of children and adolescents’ (0–19 years) first outpatient visit in Slovenia in the years 
2005 and 2015.
Diagnosis ICD-10* code Incidence 
rate/1000 in 2005
Incidence 
rate/1000 in 2015
acute viral respiratory infection J00, J04, B34.9, J06, 
J21, J22
628.5 587.2
nonspecified acute pharyngitis J02.9, J03.9 266.1 165.9
acute otitis media (suppurative) H66, H65 190.2
(24)
196.4
(32.7)
acute bronchitis/bronchiolitis J05, J20 74.4 83.6
Streptococcal pharyngitis J0.2, J0.3 23.5 37.2
Suppurative skin or/and 
subcutaneous infection
l01, l02, l03, l08 31.6 34.5
Bacterial pneumonia J13, J14, J15, J16, 
J17, J18
20.6 28.3
urinary tract infection n10, n30 12.1 13.6
acute sinusitis J01 14.1 8.9
* ICD-10–International classification of diseases, 10th revision.
on line editionOutpatient use of antibiotics in children in Slovenia
Original Scientific article
doctors and general practitioners who 
have substantially shorter education in 
paediatrics, but they prescribe only half 
the amount of paediatric prescriptions. 
In the countries with lower antibiotic 
consumption, primary care physicians 
treat the most common infections, es-
pecially respiratory tract infections, less 
commonly. Rather than immediately 
prescribe an antibiotic, the physician 
should spend more time explaining to 
patients why an antibiotic is not needed 
and about the side effects including the 
development of resistance (2,4,6). Inter-
ventions to improve antibiotic prescrib-
ing in Slovenia have been reported re-
cently (13).
A broad-spectrum penicillin co-
amoxiclav is prescribed too often in all 
age groups, especially in adolescents. Co-
amoxiclav is an alternative drug for the 
treatment of acute otitis media (OMA), 
acute bacterial rhinosinusitis and pneu-
monia, if amoxicillin monotherapy is not 
appropriate (14). We should remember to 
think critically before prescribing it and 
use amoxicillin instead, unless we are 
specifically concerned about the infec-
tion with amoxicillin-resistant bacteria 
(Haemophilus influenzae, Moraxella ca-
tarrhalis). It is important to avoid exces-
sive or inappropriate use of co-amoxiclav 
in emergency departments and primary 
care settings which has been widely rec-
ognised (14). The reasons for curbing co-
amoxiclav use are manifold, but include 
the long-term impact on antimicrobial 
resistance rates in the community, as 
well as possible patient-specific adverse 
effects (antibiotic-associated diarrhoea, 
including Clostridium difficile). A recent 
analysis has shown a positive relation-
ship between the use of co-amoxiclav 
in the community and hospital care 
and the incidence of extended spec-
trum beta-lactamase (ESBL)-producing 
bacteria (15). The resistance mechanism 
of pneumococcus against penicillin is 
not through beta-lactamase produc-
tion, therefore the therapy of infections 
caused by penicillin-resistant pneumo-
cocci with co-amoxiclav is not appropri-
ate. Instead, we should use higher doses 
of penicillin. Azithromycin is now rec-
ognized as a major driver of macrolide 
resistance due to its very long half-life 
and should not be used for the therapy 
of Streptococcus pyogenes infections; the 
use of macrolides with short half-life is 
recommended. In a 5-month retrospec-
tive study carried out In 2008/2009 
Ahčan, who spent many years working 
at the department of paediatric infec-
tious diseases, showed that penicillin 
V was the most commonly prescribed 
antibiotic (55.2 %), followed by amoxi-
cillin (33.1 %), co-amoxiclav (3.2 %), 
co-trimoxazole (3.2 %), macrolides 
(2.7 %) and antistaphylococcal antibiot-
ics (2.7 %) (16). Compared to other pri-
mary care paediatricians she prescribed 
substantially lower percentages of co-
amoxiclav (3.2 % vs. 19.5 %), macrolides 
(2.7 % vs. 6.4 %), and higher percentage 
of narrow spectrum antibiotics (Table 5). 
The goal in Sweden is that at least 80 % 
of antibiotics commonly used to treat re-
spiratory tract infections in children 0–6 
years of age should be penicillin V. In 
2015 the proportion of penicillin V was 
69 % at the national level (4).
The highest incidence rate of antibi-
otic prescriptions was observed among 
children aged 1 to 4 years at 1160 per 
1000 children in 2015. The most com-
mon cause of the high number of pre-
scriptions are common respiratory tract 
infections in children attending day-care 
centres. Based on the data of the nation-
al Statistical Office of Slovenia, 78 % of 
children aged 1–5 years are included in 
day-care centres. Every year the number 
of included children has increased (58 % 
of children included in 2006)  (17). The 
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MicrOBiOlOgy and iMMunOlOgy
number of prescribed antibiotics in Slo-
venia is too high in this age group. All 
countries with lower consumption of 
antibiotics than Slovenia have higher 
percentages of children included in day-
care centres. Also the size of children 
groups is comparable with ours  (18). 
Sweden has decreased the antibiotic con-
sumption in children aged 0–6 years by 
51 % since 2000, from 746 to 367 PTY (4). 
Also the counties with lower antibiotic 
consumption (200 PTY) continued to 
decrease the consumption significantly 
during 2014, which also suggests antibi-
otic overuse in other countries. A recent 
cohort study in the Stockholm County 
has shown no increase in the number 
of complications in patients with OMA, 
tonsillitis and sinusitis as a consequence 
of a 33 % decrease in antibiotic use (19). 
A too high prescription incidence rate 
is also being observed in the age group 
less than one year of age. Slovenia has a 
one-year maternity leave and over 50 % 
of families have only one child  (10). 
Respiratory tract infections are most 
commonly caused by viruses in this 
age group and antibiotics are likely pre-
scribed unnecessarily. It is important to 
diminish the exposure of infants to in-
dividuals with symptomatic respiratory 
tract infections.
Table 4: number of prescriptions per 1000 children (0–19 years) in 2015, by age groups and expressed in 
drug utilization 90 %.
Antibiotic Age
0–1 year
(%)
1–4 years
(%)
5–9 years 
(%)
10–14 years 
(%)
15–19 
years (%)
amoxicillin 261 (57.2) 518
(44.6)
215
(29.6)
91 (26.0) 73 (19.6)
Penicillin V 26 (5.7) 250
(21,)
262 (36.2) 104
(29.7)
74
(19.9)
co-amoxiclav 88 (19.2) 216
(18.6)
131
(18.0)
72 (20.6) 86 (23.0)
azithromycin
Miocamycin
21 (4.6) 23 (2.0) 57 (7.9) 38 (10.7) 44 (11.8)
cefuroxsime 15 (3.2) 20 (1.7)
co-trimoxazole 15 (3.2) 27 (2.3) 14 (4.0) 34 (9.2)
doxycycline 11 (3.0)
ciprofloxacin 9 (2.4)
clindamycin 9 (2.4)
Number of prescriptions 
in DU 90 %
426 
(93.4 %)
1054
(90.8 %)
665 
(91.9 %)
319
(91.1 %)
340 
(91.6 %)
Total antibiotic 
prescriptions
456 1160 723 350 371
Legend: DU – drug utilization.
on line editionOutpatient use of antibiotics in children in Slovenia
Original Scientific article
Regional variations in antibiotic use 
in children and adults are apparent in 
each analyzed year. In health regions 
in northeastern Slovenia substantially 
more antibiotics are prescribed than in 
other regions. A retrospective study on 
the consumption of antibiotics for sys-
temic use in children aged 0–14 years 
during the period 2006–2009 showed 
that in the regions with higher antibiotic 
consumption URTI and bronchitis were 
more frequently diagnosed. In 2006 
OMA and urinary tract infections were 
diagnosed more commonly as well. The 
majority of these infections is caused by 
viruses, are self-limited but commonly 
treated with antibiotics. The region with 
the highest antibiotic consumption has 
more physician visits (5 visits per child 
per year) than the region with the lowest 
consumption (3 visits), which indicates 
the importance of parents’ education 
and easy access to physicians. Primary 
care physicians are the most important 
source of information, they should edu-
cate parents when to visit the physician.
All over the world the differences in 
the frequency of prescriptions among 
individual physicians are observed (20). 
Gerber and co-workers have found a 
twofold difference in the total and a four-
fold difference in prescriptions of broad 
spectrum antibiotics (7). Physicians who 
unusually prescribe high amounts of 
antibiotics and/or broad-spectrum an-
tibiotics need additional education. If 
education is not successful other inter-
ventions should be introduced to reduce 
inappropriate prescriptions. Electronic 
prescriptions enable a better control of 
the total and the pattern of prescriptions 
which has been recently reported  (12). 
Benchmarking with other prescribers 
and introduction of accountable justifi-
cation has decreased the consumption 
of antibiotics for acute respiratory tract 
infections (21). It would be useful to up-
grade electronic prescriptions regard-
ing the total (for example a warning at 
80 % of the total average prescriptions) 
and the prescribing pattern. Recent data 
from the NIPH for 2015 show that 65 % 
of prescriptions for children and ado-
lescents were written by paediatricians 
and school medicine specialists, 16 % by 
physicians in training, 14 % by GP/fam-
ily doctors and 5 % by other specialists. 
These data show that the education of 
professionals should include all these 
specialists. We have prepared the guide-
lines for antibiotic therapy of common 
syndromes, followed by many presenta-
tions at professional meetings, yet physi-
cians seem to be reluctant to adhere to 
the recommendations (22).
Antibiotic prescription is always con-
sidered appropriate for bacterial pneu-
monia, urinary tract infections and 
Table 5: Structure of antibiotic prescribing (%) by speciality to children from 0 to 18 years in Slovenia in 2015.
Antibiotic/
Prescriber
Amoxicillin Penicillin Co-
amoxiclav
Macrolides Cephalosporins Co-
trimoxazole
Total
PTY
Paediatrician 36.8 29.3 19.5 6.4 2.8 2.6 348
School doctor 31.9 30.4 18.4 9.9 1.4 2.8 65
general practitioner 43.5 22.7 17.8 6.9 2.0 3.0 51
family doctor 42.0 27.0 16.2 5.4 1.3 2.7 37
Without specialty 31.9 23.3 26.2 5.8 1.4 3.4 100
Legend: number of prescriptions per 1000 children per year
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MicrOBiOlOgy and iMMunOlOgy
streptococcal throat infections. The inci-
dence of these infections is relatively low. 
More often the infections where recom-
mendations allow the use of antibiotics 
in certain cases, such as acute suppura-
tive otitis media, sinusitis (acute bacte-
rial sinusitis), skin and soft tissue infec-
tions and bacterial lymphadenitis are 
being diagnosed. On the basis of many 
International guidelines, antibiotics are 
not indicated in nasopharyngitis, un-
specific URTI, bronchitis, bronchiolitis, 
viral pneumonia, and non-suppurative 
acute otitis media. These infections are 
diagnosed the most frequently  (21). 
AOM is diagnosed substantially more 
commonly in Slovenia than in the Neth-
erlands where the incidence was 75/1000 
inhabitants/year in patients < 18 years of 
age in 2010-2012 (23). Also the incidence 
of AOM episodes in five East European 
countries in children below 6 years of 
age in 2011/2012 was the highest in Slo-
venia (455.4/1000 persons per year), 
and the antibiotic prescription propor-
tion was the highest in Slovenia as well 
(92.8 %) (24). These data show that AOM 
is overdiagnosed and overtreated with 
antibiotics. We urgently need additional 
education of primary care physicians 
on the correct diagnosis and appropri-
ate therapy of AOM in Slovenia (25-27). 
Because physicians in training rarely see 
patients with AOM in hospitals, training 
in a simulation centre should be orga-
nized. If we treat 10 % of patients with 
URTI (prolonged course of suppurative 
rhinitis > 10 days), 30 % of AOM (sup-
purative AOM and part of non-suppu-
rative, in infants < 6 months, bilateral in 
children < 2 years of age, after eardrum 
perforation, and/or new development of 
otorhoea, severe course or in children 
with high risk for severe course), 20 % 
with acute bronchitis (suspected pneu-
monia, children with underlying dis-
eases at high risk of complications) and 
sinusitis (acute bacterial rhinosinusitis) 
and all cases of bacterial skin and soft 
tissue infections, bacterial pneumonia, 
UTI, streptococcal throat infections and 
other rare bacterial infections with an-
tibiotics, the estimated use of antibiot-
ics would be around 250 prescriptions 
/1000 inhabitants per year (28).
The limitation of the study is that we 
were not able to obtain the percentages 
of antibiotics prescribed for individual 
diagnosis and the percentages prescribed 
in working hours and in emergency de-
partments. Regardless of the place of pre-
scriptions it is important that antibiotics 
are prescribed only if they are needed, 
this is in documented or suspected bac-
terial infections, and where the benefit 
of antibiotic therapy is greater than the 
therapy without antibiotics.
When we prescribe antibiotics we 
should always, besides the benefit for 
the patient, take into account the ?future 
ali long-term? side effects and collateral 
damage of antibiotics. In Slovenia, we 
monitor the side effects of drugs includ-
ing antimicrobials poorly. A recent Ca-
nadian study has shown that of all drugs, 
the side effects of antimicrobials are 
the most common cause for visiting an 
emergency department  (29). When we 
prescribe antibiotics we should always 
bear in mind potential long-term side 
effects of antibiotics. Over the last few 
years many studies have been published 
confirming the correlation between an-
tibiotic usage in early childhood and 
various autoimmune diseases (juvenile 
rheumatoid arthritis, chronic inflamma-
tory bowel disease), obesity, which can 
present the tip of the iceberg from all 
long-term side effects.
The selection pressure of antibiot-
ics on normal flora and pathogens, and 
secretion in the environment are well 
known but not sufficiently taken into 
account. In Slovenia, the levels of pneu-
on line editionOutpatient use of antibiotics in children in Slovenia
Original Scientific article
mococcal resistance to penicillin and 
macrolides are higher in children be-
cause of a higher use of antibiotics in 
children than in adults. Higher regional 
consumption of penicillins is associated 
with higher resistance of Streptococcus 
pneumoniae to penicillin (3).
5. Conclusion
In Slovenia, the total consumption, 
especially the consumption of broad 
spectrum antibiotics such as co-amoxi-
clav, azithromycin and cephalosporins of 
the second and third generations is too 
high. The majority of antibiotics (more 
than 80 %) are prescribed by paediatri-
cians, specialists of school medicine and 
physicians in training. To improve the 
prescription rates, the recommenda-
tions for antibiotic prescriptions should 
be followed. Self-education and more 
responsible antibiotic prescriptions in 
all age groups especially in preschool 
children are needed. All health regions 
in Slovenia should lower antibiotic con-
sumption, especially northeastern re-
gions. Antimicrobial resistance is such 
a great public health problem that we 
cannot permit inappropriate antibiotic 
prescriptions.
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