Utilization of Injectable Drugs for Communicable and Non-communicable Diseases in Primary Healthcare: A Retrospective Study in Turkey

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injectables, antibiotics, analgesics, primary care, thiocolchicoside


Objective: Primary care, which is often the first level of contact for patients with various communicable diseases (CDs) and noncommunicable diseases (NCDs), might exhibit patterns of injectable drug utilization different from hospitals. We aimed to examine injection prescribing to adults with CD or NCD in primary care.

Methods: In this retrospective study, single-diagnosis injectable drug-containing prescription data from Family Medicine Information System comprising 32 provinces of Turkey were analysed. The prescriptions were grouped by diagnosis as “CD” (n=3848) and “NCD” (n=9338). Injectable drug utilization patterns in these groups were analysed by demographics, diagnoses, and drug subgroups.

Results: Out of 13186 prescriptions, 70.8% were issued for NCDs. NCD prescriptions were mostly generated for women and elderly (p<0.05 for both). About 63.3% (n=2948) of injectable drugs in CD prescriptions were antibiotics and 12.6% were analgesics. Cefazolin (15.2%) was the most commonly prescribed antibiotic for acute pharyngitis and acute sinusitis, and benzathine benzylpenicillin (12.8%) was the top-choice for acute tonsillitis and rheumatic fever. In NCD prescriptions, 34.0% (n=4214) of injectable agents were analgesics and 16.9% were muscle relaxants. The most frequently encountered drug in NCD prescriptions was thiocolchicoside (16.3%), which was the top-choice in all seven common musculoskeletal diagnoses.

Conclusion: Muscle relaxants and analgesics were the most commonly prescribed injectable drugs for NCDs, musculoskeletal diseases in particular. Antibiotics were frequently encountered in CD prescriptions, mostly as broad-spectrum for lower respiratory tract infections (RTIs) and narrow-spectrum for upper RTIs. These findings may elucidate the issues to especially focus on regarding excessive use of injections.


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Patel A, Patel M, Yang X, Mitra A. Recent advances in protein and peptide drug delivery: a special emphasis on polymeric nanoparticles. Protein Pept Lett. 2014;21(11):1102-1120.

World Health Organization. WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings. Geneva: World Health Organization; 2016.

World Health Organization. Promoting rational use of medicines: core components, policy perspectives on medicines. Geneva: World Health Organization; 2002:1e6.

Atif M, Scahill S, Azeem M, Sarwar MR, Babar ZUD. Drug utilization patterns in the global context: A systematic review. Health Policy Technol. 2017;6(4):457-470.

Mollahaliloglu S, Alkan A, Donertas B, Ozgulcu S, Akici A. Prescribing practices of physicians at diferent health care institutions. Eurasian J Med. 2013;45(2):92-98.

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-1858.

Turkish Ministry of Health. Multisectoral action plan on noncommunicable diseases (2017–2025). Publication number 1057, Ankara; 2017.

Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, et al. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832-840.

Bodenschatz C, Talaat M, Kandeel A, Lohiniva AL, Radwan E, Mahoney F. Injection prescribing patterns in public health care facilities in Egypt. East Mediterr Health J. 2009;15(6):1440-1448.

Aksoy M, Alkan A, İşli F. Rational drug use promotional activities of Ministry of Health. Turkiye Klinikleri J Pharmacol-Special Topics 2015;3(1):19-26.

T.C. Kalkınma Bakanlığı. İllerin ve bölgelerin sosyo-ekonomik gelişmişlik sıralaması araştırması (SEGE-2011) [Turkish Ministry of Development, Survey of socio-economic development ranking of provinces and regions], Ankara; 2013.

WHO Collaborating Centre for Drug Statistics Methodology, ATC classification index with DDDs, 2022. Oslo, Norway 2021. Accessed 19 Mar 2022. Available from URL: https://www.whocc.no/atc_ddd_index/

Bayram D, Vızdıklar C, Aydın V, İşli F, Akıcı A. Investigation of prescribing trends and prescriptions for common diagnoses in primary care: Nationwide data of Turkey. Cukurova Medical Journal. 2020;45(2):695-708.

Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Family Practice. 2016;17(1):38.

Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Accessed March 16, 2022. Available from URL: http://vizhub.healthdata.org/gbd-compare

Roser M, Ritchie H. Burden of disease. Our World in Data. Published 2021. Accessed March 16, 2022. Available from URL: https://ourworldindata.org/burden-of-disease#citation

Janjua NZ, Hutin YJ, Akhtar S, Ahmad K. Population beliefs about the efficacy of injections in Pakistan’s Sindh province. Public Health. 2006;120(9):824-833.

Maxwell SR. Rational prescribing: the principles of drug selection. Clin Med (Lond). 2016;16(5):459-464.

European Medicines Agency. European Medicines Agency recommends restricting use of thiocolchicoside by mouth or injection; 2013. Accessed March 16, 2022. Available from URL: https://www.ema.europa.eu/en/news/european-medicines-agency-recommends-restricting-use-thiocolchicoside-mouth-injection

T.C. Sağlık Bakanlığı Türkiye İlaç ve Tıbbi Cihaz Kurumu. Ek izlemeye tabi ilaçlar listesi. [Turkish Ministry of Health Turkish Medicines and Medical Devices Association, List of medicines under additional monitoring] Accessed March 16, 2022. Available from URL: https://www.titck.gov.tr/dinamikmodul/57?page=1

Cashin AG, Folly T, Bagg MK, Wewege MA, Jones MD, Ferraro MC, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. 2021;374:n1446.

World Health Organization. Global status report of noncommunicable diseases 2014. World Health Organization, Geneva; 2014. Accessed March 16, 2022. Available from URL: https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf

Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-180.

Turkish Society of Endocrinology and Metabolism Diabetes Mellitus Study Group. Diagnosis, treatment and monitoring guideline of diabetes mellitus and its complications; 2020. Accessed March 16, 2022. Available from URL: https://file.temd.org.tr/Uploads/publications/guides/documents/20200625154506-2020tbl_kilavuz86bf012d90.pdf

Tiwari SA, Baburao GB. ATC/DDD method to assess the injectable antibiotics utilization in a tertiary care teaching general hospital in India. IOSR J of Dent Med Sciences. 2017;16(6):39-43.

Esposito S, Noviello S, Boccazzi A, Tonelli P. Management of upper respiratory tract infections in primary care in Italy: a national survey. Int J Antimicrob Agents. 2001;17(3):189-194.

Abou-Shaaban M, Ali AA, Rao PGM, Majid A. Drug utilization review of cephalosporins in a secondary care hospital in United Arab Emirates. Int J Clin Pharm. 2016;38(6):1367-1371.

Martinez ME. The calendar of epidemics: Seasonal cycles of infectious diseases. PLOS Pathogens. 2018;14(11):e1007327.

Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents and Chemother. 2014;58(5):2763-2766.

Sahin A, Akici A, Aydin V, Melik B, Aksoy M, Alkan A. Variation of antibiotic consumption and its correlated factors in Turkey. Eur J Clin Pharmacol. 2017;73(7):867-873.




How to Cite

Çolak, S. T., Vızdıklar, C., Aydın, V., Ayaz, B. D., Alkan, A., & Akıcı, A. (2023). Utilization of Injectable Drugs for Communicable and Non-communicable Diseases in Primary Healthcare: A Retrospective Study in Turkey. European Journal of Therapeutics, 29(1), 23–31. https://doi.org/10.58600/eurjther-341



Original Articles