a5711e91425c1caa737e97b0e17491f1 pmc_34680730.pdf 668f250e066e7048186ac07d87f11eea6422c7cd pmc_34680730.pdf 189302a09a461527529b35e1ebe78bc9be00041729ac2311bc3e1aae08aa916d pmc_34680730.pdf Title: Impact of Generic Entry on Hospital Antimicrobial Use:A Retrospective Quasi-Experimental Interrupted TimeSeries Analysis Subject: Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p < 0.001), meropenem (0.54, p < 0.001), and piperacillin-tazobactam (0.13, p < 0.001) increased, whereas the use of clindamycin (-0.03, p < 0.001) and itraconazole (-0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (-0.07), ampicillin (-0.02), cefixime (-0.06), fluconazole (-0.13), imipenem–cilastatin (-0.50) and levofloxacin (-0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE. Keywords: antibiotic policy; generic antibiotics; branded antibiotics; antibiotics; defined daily doses; antimicrobial consumption Author: Mercè Espona, Daniel Echeverria-Esnal, Sergi Hernandez, Alexander Almendral, Silvia Inés Gómez-Zorrilla, Enric Limon, Olivia Ferrandez and Santiago Grau Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sun Sep 26 03:18:06 2021 CEST ModDate: Sun Sep 26 03:30:20 2021 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1350189 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ERWKYT+VnURWPalladioL Type 1 Custom yes yes no 10 0 FHQISH+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 RVAINC+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 EUROKJ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 FXXUVH+CMSY10 Type 1 Builtin yes yes no 28 0 JFQOLP+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 41 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 63 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 67 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 71 0 ZDEXTA+URWPalladioL-BoldItal Type 1 Custom yes yes no 86 0 NHKCCC+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 100 0 NHKCCE+PalatinoLinotype TrueType WinAnsi yes yes no 103 0 NHKCCG+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 106 0 NHKDPN+Calibri,Bold CID TrueType Identity-H yes yes yes 109 0 CIDFont+F3 CID TrueType Identity-H yes no yes 124 0 CIDFont+F1 CID TrueType Identity-H yes no yes 132 0 CIDFont+F2 CID TrueType Identity-H yes no yes 140 0 CIDFont+F5 CID TrueType Identity-H yes no yes 148 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-11-23 05:27:10 CET RepresentationInformation: pmc_34680730.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:05:55 CEST Size: 1350189 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 310 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Item: Title: Discussion Destination: section.3 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Study Setting and Design Destination: subsection.4.1 Item: Title: Data Collection Destination: subsection.4.2 Item: Title: Statistical Analysis Destination: subsection.4.3 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Impact of Generic Entry on Hospital Antimicrobial Use:A Retrospective Quasi-Experimental Interrupted TimeSeries Analysis Author: Mercè Espona, Daniel Echeverria-Esnal, Sergi Hernandez, Alexander Almendral, Silvia Inés Gómez-Zorrilla, Enric Limon, Olivia Ferrandez and Santiago Grau Subject: Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p < 0.001), meropenem (0.54, p < 0.001), and piperacillin-tazobactam (0.13, p < 0.001) increased, whereas the use of clindamycin (-0.03, p < 0.001) and itraconazole (-0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (-0.07), ampicillin (-0.02), cefixime (-0.06), fluconazole (-0.13), imipenem cilastatin (-0.50) and levofloxacin (-0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE. 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