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1 Health Insurance Institute 
of Slovenia, Ljubljana, 
Slovenia
2 National institute of 
Public Health, Lubljana, 
Slovenia
3 Faculty of Pharmacy, 
University of Ljubljana, 
Ljubljana, Slovenia
Correspondence/
Korespondenca:
Tatja Kostnapfel, e: tatja.
kostnapfel@nijz.si
Key words:
quality indicator; defined 
daily dose; prescribing 
systemic antibiotics
Ključne besede:
kazalnik kakovosti; 
definirani dnevni odmerek; 
predpisovanje sistemskih 
antibiotikov
Received: 16. 9. 2019
Accepted: 14. 4. 2020
eng slo element
en article-lang
10.6016/ZdravVestn.2983 doi
16.9.2019 date-received
14.4.2020 date-accepted
Public Health (Occupational medicine) Javno zdravstvo (varstvo pri delu) discipline
Review article Pregledni znanstveni članek article-type
Quality indicators of prescribed pediatrics 
medicines
Kazalniki kakovosti predpisovanja zdravil v pedi-
atriji
article-title
Quality indicators of prescribed pediatrics 
medicines
Kazalniki kakovosti predpisovanja zdravil v pedi-
atriji
alt-title
quality indicator, defined daily dose, prescrib-
ing systemic antibiotics
kazalnik kakovosti, definirani dnevni odmerek, 
predpisovanje sistemskih antibiotikov
kwd-group
The authors declare that there are no conflicts 
of interest present.
Avtorji so izjavili, da ne obstajajo nobeni 
konkurenčni interesi.
conflict
year volume first month last month first page last page
2020 89 7 8 408 422
name surname aff email
Tatja Kostnapfel 2 tatja.kostnapfel@nijz.si
name surname aff
Jurij Fürst 1
Mitja Kos 3
eng slo aff-id
Health Insurance Institute of 
Slovenia, Ljubljana, Slovenia
Zavod za zdravstveno 
zavarovanje Slovenije, Ljubljana, 
Slovenija
1
National institute of Public 
Health, Lubljana, Slovenia
Nacionalni inštitut za javno 
zdravje, Ljubljana, Slovenija
2
Faculty of Pharmacy, University 
of Ljubljana, Ljubljana, Slovenia
Fakulteta za farmacijo, Univerza v 
Ljubljani, Ljubljana, Slovenija
3
Quality indicators of prescribed pediatrics 
medicines
Kazalniki kakovosti predpisovanja zdravil v pediatriji
Jurij Fürst,1 Tatja Kostnapfel,2 Mitja Kos3
Abstract
Background: Indicators of prescribed medicines represent selected data providing a partial in-
sight into physicians’ work in the field of drug prescribing. They are based on the data on drug 
prescriptions issued. The Health Insurance Institute of Slovenia (HIIS), in cooperation with the 
representatives of paediatric specialty, prepared an array of drug prescribing quality indicators 
for paediatrics. Indicators for the 5-year period between 2014 and 2018 were analysed.
Methods: The retrospective observational study analysed the data on the medicines prescribed 
to children aged up to 19 years. The data were obtained from the Primary Care Prescriptions Da-
tabase at the HIIS and at the National Institute of Public Health. The consumption of medications 
is shown according to the anatomical therapeutic chemical (ATC) classification in DDD. Medica-
tion subgroups within the ATC groups were also reviewed. The data are shown in tabular format.
Results: The number of prescriptions issued for children in 2014–2018 in Slovenia is lower by 
8%, while the number of DDD prescribed in the same period was higher by 4%. The highest per-
centage of persons receiving at least one prescription for systemic treatment of bacterial infec-
tions was observed in the Murska Sobota HIIS regional unit, i.e., 35%, followed by regional units 
Krško with 34.1%, Ravne with 33.2% and Novo mesto with 32%. The fewest persons received 
medications in the Nova Gorica regional unit. The KK1p indicator, which reflects the value of a 
defined daily dose (DDD) unit or the average price per unit of all medications prescribed in Slove-
nia, shows a downward trend for Slovenia as well as major differences between the HIIS regional 
units. Compared to the baseline year, there was a 16% reduction in the proportion of children 
having received a prescription for an antibiotic. The reduction observed for the Nova Gorica re-
gional unit amounted to 33%.
Conclusion: The indicators presented show an improved quality of drug prescribing for children, 
notably regarding systemic antibiotics. We believe the indicators are useful both for individual 
physicians and for decision-making at national level. They also contribute to further control of 
antimicrobial use in children, which is their main purpose.
Izvleček
Izhodišče: Kazalniki predpisovanja zdravil so izbrani podatki, ki delno osvetljujejo zdravniko-
vo delo na področju predpisovanja zdravil. Temeljijo na podatkih o izdanih zdravilih na recept. 
Zavod za zdravstveno zavarovanje Slovenije (ZZZS) je v sodelovanju s predstavniki pediatrične 
stroke pripravil nabor kazalnikov kakovosti predpisovanja zdravil na področju pediatrije. Prip-
ravljena je analiza kazalnikov za petletno obdobje od leta 2014–2018.
Metode: V retrospektivni, opazovalni raziskavi so bili analizirani podatki o predpisanih zdravilih 
otrokom do 19. leta starosti. Vir podatkov je baza ambulantno predpisanih zdravil na ZZZS in na 
Slovenian
Medical
Journal
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Quality indicators of prescribed pediatrics medicines
1 Introduction
World Health Organization (WHO) 
defines rational use of medicines (RUM) 
as: “patients receive medications appro-
priate to their clinical needs, in doses that 
meet their own individual requirements, 
for an adequate period of time, and at the 
lowest cost to them and their communi-
ty.” RUM lowers risks, improves benefits, 
saves resources and contributes to fair 
availability (1,2,3).
Total annual extent of antibiotic pre-
scriptions in number of users per 100 pa-
tient-years was 18% in the Netherlands, 
36.2% in the United Kingdom, and 52.0% 
in Italy. Their use was the highest in the 
first couple of years of life. The number 
of antibiotics that represent 90% of drugs 
for children was comparable. The index of 
amoxicillin was the highest in the Nether-
lands and the United Kingdom (50–60%), 
the lowest in Italy (30%), however, over 
Nacionalnem inštitutu za javno zdravje (NIJZ). V analizo so bili vključeni podatki o številu am-
bulantno predpisanih zdravil na zelenih in belih receptih. Poraba zdravil je prikazana glede na 
razvrstitev po anatomsko-terapevtski-kemični (ATC) klasifikaciji v definiranih dnevnih odmerkih 
(DDD). Pregledane so bile tudi podskupine zdravil znotraj skupin ATC. Podatki so prikazani v ta-
belah.
Rezultati: Število izdanih receptov v Sloveniji se je zmanjšalo za 8 %, vendar se je poraba zdravil 
v DDD povečala za 4 %. Najvišji delež oseb, ki so prejele vsaj en recept za zdravila za sistemsko 
zdravljenje bakterijskih okužb, je bil v območni enoti (OE) Murska Sobota 35 %, sledijo OE Krško 
s 34,1 %, OE Ravne s 33,2 % in OE Novo mesto z 32 %. Najmanj oseb je zdravila prejelo v OE Nova 
Gorica – 21,1 %. Kazalnik KK1p, ki kaže strošek predpisanih zdravil na enoto DDD, kaže padajoči 
trend za Slovenijo in velike razlike med območnimi enotami ZZZS. Glede na izhodiščno leto je v 
Sloveniji prišlo do zmanjšanja deleža otrok, ki so prejeli recept za antibiotik za sistemsko zdravl-
jenje, za 16 %. V OE Nova Gorica je to zmanjšanje kar 33-odstotno.
Zaključek: Predstavljeni kazalniki kažejo izboljšanje kakovosti predpisovanja zdravil pri otrocih 
zlasti na področju sistemskih antibiotikov. Menimo, da so kazalniki koristni tako za posamezne 
zdravnike kot za odločanje na nacionalni ravni. Lahko prispevajo k nadaljnjemu obvladovanju 
porabe protimikrobnih zdravil pri otrocih, kar je njihov osnovni namen.
Cite as/Citirajte kot: Fürst J, Kostnapfel T, Kos M. Quality indicators of prescribed pediatrics medicines. 
Zdrav Vestn. 2020;89(7–8):408–22.
DOI: https://doi.org/10.6016/ZdravVestn.2983
Copyright (c) 2020 Slovenian Medical Journal. This work is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License.
time it declined in the United Kingdom 
and Italy (4,5).
The indicators for prescribing medi-
cines are select data that partially high-
light the physician’s work in medication 
prescription. They are based on drugs is-
sued on prescription. In cooperation with 
paediatric representatives, the Health In-
surance Institute of Slovenia (HIIS) pre-
pared a range of indicators of the quality 
of drug prescription in paediatrics. The 
analysis of indicators for the 2014–2018 
period has been completed (6,7,8,9). The 
A/B indicator has been added, showing 
the proportion between number of people 
who received amoxicillin, and the number 
of people who received broad spectrum 
antibiotics. The analysis supports interna-
tional comparison (4).
In this retrospective, observational, 
descriptive study, we analysed groups of 
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medicines prescribed between 2014 and 
2018, which were the basis for determin-
ing the indicators of quality. The indicators 
were divided into three groups: the first 
defines the general indicators that include 
the size of the DDD unit, the number of 
prescriptions of a standardized receptor, 
the DDD number per standardized recep-
tor and the share of prescription recipi-
ents among children. The second group 
includes indicators pertaining to the pre-
scription of drugs for systemic infection 
treatment, and the third one includes indi-
cators pertaining to prescribing antibiotics 
or chemotherapy drugs for local therapy.
2 Material and methods
The analysis included all the paediatri-
cians and general/family medicine phy-
sicians, who treated 100 or more people, 
aged up to 19 years. All analyses include 
drugs that were issued at pharmacies in 
Slovenia and were prescribed on public 
and private prescriptions to persons aged 
up to 19 years. Even though an e-prescrip-
tion also includes the data on prescribed 
drugs, all the indicators only take into ac-
count those issued in pharmacies in Slo-
venia. The data on the issued medicines 
comes from HIIS’s prescription database, 
where all the data on paper and eprescrip-
tions are gathered, and the database of pre-
scribed drugs in the Republic of Slovenia 
National Institute of Public Health (NIJZ) 
(9,11). The data on the doctor, provider 
and employments come from the database 
on providers – the Registry of Healthcare 
Providers and Workers (RIZDDZ) and the 
data on selected personal physicians. If a 
physician has more than one employment, 
all prescriptions are contributed to their 
basic employment. If their basic employ-
ment is not in clinical practice, the sup-
plemental employment is counted in the 
analysis. The indicators are calculated on 
a yearly basis and take into account the 
drugs that were issued in pharmacies in a 
given year. Every indicator is displayed for 
Slovenia and for all of HIIS’s regional units 
(RU).
Some indicators take into account the 
age-standardised population. This number 
is a theoretical value at which we presup-
pose that the age structure of the partici-
pating population is the same as in stan-
dard population. It tells us what the value 
would be in an observed population, if the 
age structure of this population would be 
the same as in the standard population. 
The ponders for defining standardised 
population change every year depending 
on the number of children and the value 
of prescribed drugs in an individual age 
group. The data for ponders are calculat-
ed by yearly age intervals for recipients of 
drugs for ages from 0 to 19. The indica-
tors are displayed by ages for the period 
of 5 years. A single methodology is used 
for all ages. This makes the data for every 
physician comparable by year, reflect-
ing the changes in the physician’s work. 
If the value of an indicator is 20% above 
the average, it is coloured green, while red 
marks indicators 20% below average. The 
methodology is described in more detail 
on HIIS’s website, where all indicators and 
data on prescribed drugs can be accessed 
(6,7,8).
The usage of drugs is listed by their 
placement according to the anatom-
ic-therapeutic-chemical (ATC) classifica-
tion. Subgroups of drugs from the ATC 
groups, namely ATC group J01 (drugs 
for systemic treatment of bacterial infec-
tions), antibiotics, and chemotherapeutics 
for local treatment, which include drugs 
from ATC groups D06AX01, D06AX07, 
D06AX09, S01AA12, S01AA26, S01AD03, 
S01AE03, S01AE07 and S01CA01, were 
also reviewed. The use of antibiotics for 
systemic treatment was expressed in de-
fined daily doses (DDD), and the use of 
antibiotics and chemotherapeutics for lo-
cal treatment in the number of packs, be-
cause there is no DDD defined for them. 
DDD is the assumed average maintenance 
dose per day for a drug used for its main 
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Quality indicators of prescribed pediatrics medicines
indication in adults. It is defined by the 
WHO Collaborating Centre for Drug Sta-
tistics Methodology in Oslo for drugs that 
have been assigned ATC labels. DDD is 
a fixed measurement unit, independent 
from the price and pharmaceutical form, 
which allows for an assessment of the need 
for using drugs and comparison between 
population groups (10,11).
3 Results
3.1 Primary data
Primary data shows that the number of 
physicians with 100 or more defined peo-
ple, aged up to 19, has increased from 303 
to 311 over five years, i.e., 3%, the same as 
the number of defined children. With in-
creased total use of medicines in DDD by 
Table 1: Basic data for calculating indicators.
2014 2018 Index
No. of physicians 303 311 103
Number of defined children 34,854 35,826 103
Number of standardised defined children 26.431 27,040 102
Patient consultation rate 45,015 46,137 102
No. of prescriptions 87,031 80,333 92
No. of recipients of prescriptions 31,046 29,493 95
Number of defined prescription recipients 18,804 18,333 97
Total value of prescriptions with VAT (EUR) 931,418 915,089 98
Total use of prescription drugs in DDD 960,748 1,002,241 104
Table 2: Indicator KK1p – the cost of prescribed drugs per DDD unit over the 2014–2018 period 
in Slovenia and RU HIIS.
2014 2015 2016 2017 2018 Index 2018/2014
Slovenija 0.97 € 0.98 € 0.97 € 0.96 € 0.91 € 94
Celje 1.04 € 1.09 € 1.07 € 1.08 € 1.12 € 108
Koper 0.93 € 0.92 € 0.90 € 0.93 € 0.94 € 101
Krško 0.91 € 0.91 € 0.85 € 0.80 € 0.83 € 92
Kranj 1.04 € 1.02 € 1.06 € 1.11 € 1.05 € 101
Ljubljana 0.98 € 0.98 € 0.96 € 0.97 € 0.91 € 93
Maribor 0.96 € 1.02 € 1.02 € 0.94 € 0.85 € 89
Murska Sobota 1.04 € 1.06 € 1.11 € 1.08 € 1.01 € 98
Nova Gorica 0.84 € 0.81 € 0.75 € 0.72 € 0.66 € 78
Novo mesto 0.78 € 0.74 € 0.77 € 0.77 € 0.75 € 96
Ravne na Koroškem 1.08 € 1.11 € 1.07 € 1.05 € 1.01 € 93
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4%, the number of prescription recipients 
has decreased by 5%, and the total value of 
prescriptions by 2%. The average physician 
included in the indicator had 1,156 defined 
children in 2018 (range of 105–2,768), 872 
age standardised children (range of 101–
2,109) and the patient consultation rate of 
1,488 (range of 102–3,697), taken into ac-
count for the reviewed population of chil-
dren (Table 1).
3.2 General indicators
We will present the 14 indicators of 
quality for prescribing drugs in paediat-
rics.
KK1p – the cost of prescribed medicines 
per DDD unit
The indicator shows the value of the 
DDD unit, i.e., the average price per unit 
for all prescribed drugs in EUR (Table 2). 
The indicator points to a declining trend 
for Slovenia, and major differences be-
tween RU of HIIS. The index in Slovenia 
was 94. The highest growth was recorded 
in Celje (index of 108), followed by Koper 
and Kranj. The biggest decline of the DDD 
value was in Nova Gorica (index of 78) 
and in Maribor (index of 92).
KK2p – age-standardised number of 
prescriptions per recipient
The indicator shows the age-stan-
dardised number of prescriptions of all 
medicines prescribed at out-patient clinics 
of the selected prescriber per recipient. At 
the national level, a 3% decrease is visible, 
while at individual RUs, there was an in-
crease. RU Krško recorded a growth of 6%, 
followed by Kranj and Ljubljana. All other 
RUs recorded a decrease in the number of 
issued prescriptions (Table 3). As no value 
is marked green, this means that there are 
no derogations from the Slovenian average 
that would be less than 20%. All deroga-
tions were higher, and are marked in red.
KK2p – age-standardised number of 
DDD medicines per recipient
The indicator shows the age-stan-
dardised number of DDD medicines per 
recipient. It shows fluctuating data with 
the lowest values for 2015. As the previ-
ous indicator shows, the number of issued 
prescriptions in Slovenia decreased by 3%; 
however, the use of medicines, as shown 
by this indicator, has increased, as there 
were 9% more DDDs prescribed (Table 3).
3.3 Prescribing medicines for 
systemic infection treatment
KK4p – share of people who received the 
drugs for systemic treatment of bacterial 
infections
The indicator shows the ratio between 
the number of defined children whose 
physician prescribed at least one antibiotic 
(ATC: J01) and the number of all defined 
children of this physician (Table 4). On 
average, half of defined children receive at 
least one prescription for an antibiotic (in 
individual RUs the percentage is between 
47% and 64%), with a clear shift towards 
decrease in most RUs. In Slovenia there is a 
Table 3: Indicator KK2p – age-standardised number of prescriptions per recipient, and indicator KK3p – age-
standardised DDD number per recipient over the 2014–2018 period in Slovenia and RU HIIS with corresponding indices.
KK2p – age-standardised number of prescriptions per 
recipient
KK2p – age-standardised number of DDD medicines 
per recipient
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 3.6 3.4 3.7 3.7 3.5 97 40.2 36.7 42.3 42.6 43.9 109
Celje 3.7 3.4 3.9 3.7 3.5 94 40.4 35.6 41.4 39.9 38.5 95
Koper 3.7 3.3 3.7 3.7 3.5 93 43.6 38.6 43 42.8 40 92
Krško 5.1 4.9 5.3 5.4 5.4 106 53.4 50.4 57.6 59.2 61.6 115
Kranj 3.1 2.9 3.2 3.3 3.1 101 34.7 33.7 38.5 38.3 39 112
Ljubljana 3,2 3 3.3 3.3 3.2 100 36.3 33.9 39.1 39.6 41.9 115
Maribor 4 3.7 4 3.9 3.7 94 40.4 35.5 40.5 40.6 43.6 108
Murska 
Sobota
4.8 4.3 4.9 5 4.5 95 48.7 41.3 48.7 50.7 49.1 101
Nova 
Gorica
3.7 3.2 3.5 3.3 3.3 89 47.9 43.1 54 .2 54.9 62.5 131
Novo 
mesto
3.8 3.4 3.6 3.6 3.4 90 48 44.1 48.4 48.9 49.6 103
Ravne na 
Koroškem
4.1 3.8 4.1 4 3.8 92 41.2 36.7 43,2 42.1 43.4 105
Table 4: Indicator KK4p – share of defined people who received the medicines for systemic 
treatment of bacterial infections in the 2014–2018 period by RU with corresponding indices. 
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 54% 53% 52% 52% 51% 95
Celje 50% 51% 49% 51% 48% 96
Koper 61% 56% 54% 56% 53% 87
Krško 62% 64% 63% 62% 62% 100
Kranj 45% 47% 46% 47% 47% 103
Ljubljana 50% 49% 48% 49% 48% 96
Maribor 60% 58% 56% 56% 56% 93
Murska Sobota 68% 66% 66% 66% 64% 95
Nova Gorica 54% 50% 48% 47% 47% 86
Novo mesto 59% 57% 55% 56% 54% 91
Ravne na Koroškem 56% 56% 53% 51% 50% 90
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Quality indicators of prescribed pediatrics medicines
tions were higher, and are marked in red.
KK2p – age-standardised number of 
DDD medicines per recipient
The indicator shows the age-stan-
dardised number of DDD medicines per 
recipient. It shows fluctuating data with 
the lowest values for 2015. As the previ-
ous indicator shows, the number of issued 
prescriptions in Slovenia decreased by 3%; 
however, the use of medicines, as shown 
by this indicator, has increased, as there 
were 9% more DDDs prescribed (Table 3).
3.3 Prescribing medicines for 
systemic infection treatment
KK4p – share of people who received the 
drugs for systemic treatment of bacterial 
infections
The indicator shows the ratio between 
the number of defined children whose 
physician prescribed at least one antibiotic 
(ATC: J01) and the number of all defined 
children of this physician (Table 4). On 
average, half of defined children receive at 
least one prescription for an antibiotic (in 
individual RUs the percentage is between 
47% and 64%), with a clear shift towards 
decrease in most RUs. In Slovenia there is a 
Table 3: Indicator KK2p – age-standardised number of prescriptions per recipient, and indicator KK3p – age-
standardised DDD number per recipient over the 2014–2018 period in Slovenia and RU HIIS with corresponding indices.
KK2p – age-standardised number of prescriptions per 
recipient
KK2p – age-standardised number of DDD medicines 
per recipient
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 3.6 3.4 3.7 3.7 3.5 97 40.2 36.7 42.3 42.6 43.9 109
Celje 3.7 3.4 3.9 3.7 3.5 94 40.4 35.6 41.4 39.9 38.5 95
Koper 3.7 3.3 3.7 3.7 3.5 93 43.6 38.6 43 42.8 40 92
Krško 5.1 4.9 5.3 5.4 5.4 106 53.4 50.4 57.6 59.2 61.6 115
Kranj 3.1 2.9 3.2 3.3 3.1 101 34.7 33.7 38.5 38.3 39 112
Ljubljana 3,2 3 3.3 3.3 3.2 100 36.3 33.9 39.1 39.6 41.9 115
Maribor 4 3.7 4 3.9 3.7 94 40.4 35.5 40.5 40.6 43.6 108
Murska 
Sobota
4.8 4.3 4.9 5 4.5 95 48.7 41.3 48.7 50.7 49.1 101
Nova 
Gorica
3.7 3.2 3.5 3.3 3.3 89 47.9 43.1 54 .2 54.9 62.5 131
Novo 
mesto
3.8 3.4 3.6 3.6 3.4 90 48 44.1 48.4 48.9 49.6 103
Ravne na 
Koroškem
4.1 3.8 4.1 4 3.8 92 41.2 36.7 43,2 42.1 43.4 105
Table 4: Indicator KK4p – share of defined people who received the medicines for systemic 
treatment of bacterial infections in the 2014–2018 period by RU with corresponding indices. 
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 54% 53% 52% 52% 51% 95
Celje 50% 51% 49% 51% 48% 96
Koper 61% 56% 54% 56% 53% 87
Krško 62% 64% 63% 62% 62% 100
Kranj 45% 47% 46% 47% 47% 103
Ljubljana 50% 49% 48% 49% 48% 96
Maribor 60% 58% 56% 56% 56% 93
Murska Sobota 68% 66% 66% 66% 64% 95
Nova Gorica 54% 50% 48% 47% 47% 86
Novo mesto 59% 57% 55% 56% 54% 91
Ravne na Koroškem 56% 56% 53% 51% 50% 90
5% decrease in recipients of prescriptions. 
The growth of prescription recipients was 
recorded only in RU Kranj (index of 103).
KK5p – share of people who received 
medicines for systemic treatment of in-
fections
The indicator shows the share of pre-
scription recipients for antibiotics (ATC: 
J01) among all prescription recipients (Ta-
ble 5). The difference compared to KK4p is 
that here all children who were prescribed 
an antibiotic are taken into account, not 
only those who were defined for it. With 
regard to the first year, all RUs recorded a 
decrease in the share of children who re-
ceived a prescription for an antibiotic by 
14%. At RU Nova Gorica, this decrease 
amounted to 33%. In 2014, the first year 
of the survey, the differences between 
the RUs were significantly lower than in 
2018, which shows that over the past five 
years, physicians in certain RUs have ap-
proached management of antibiotic use 
more aggressively.
KK6p – age-standardised level of de-
fined people (number/1000 people) who 
received medicines for systemic treat-
ment of bacterial infections among all 
the defined people
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The indicator shows the number of de-
fined recipients of antibiotics (ATC: J01) 
per 1000 defined children (Table 5). When 
defining the population of the recipients, 
the age structure of recipients is taken in-
to account (standardisation), just like with 
KK2p. In most RUs, there was a significant 
shift towards improvement over the past 
five years, with the differences between 
RUs in 2018 increasing compared to the 
first year. The index for Slovenia is 78.
KK7p – share of use (in DDD) of drugs 
for systemic treatment of bacterial infec-
tions among all prescribed drugs
The indicator shows the number of 
DDD units of prescribed antibiotics (ATC: 
J01) in the number of DDD units of all 
prescribed medicines (Table 6). 
KK8p – share of people who received a 
second prescription for drugs for sys-
temic treatment of bacterial infections
Table 5: Indicator KK5p – the share of people who received drugs for systemic treatment of infections, and indicator 
KK6p – age-standardised level of defined people (number/1000 people) who received medicines for systemic treatment 
of infections of all defined in the 2014–2018 period in Slovenia and by RU HIIS with corresponding indices.
KK5p – share of people who received medicines for 
systemic treatment of bacterial infections
KK6p – age-standardised level of defined people 
(number/1000 people) who received medicines for 
systemic treatment of bacterial infections 
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 42% 40% 39% 37% 35% 84 238 221 208 197 186 78
Celje 42% 39% 37% 36% 34% 80 230 223 198 206 179 78
Koper 44% 40% 40% 38% 36% 82 277 228 229 218 191 69
Krško 41% 42% 43% 39% 41% 98 281 292 300 265 272 97
Kranj 38% 37% 36% 34% 33% 89 180 177 172 162 159 88
Ljubljana 41% 38% 36% 34% 34% 82 208 187 175 165 159 76
Maribor 42% 42% 41% 38% 35% 84 266 257 239 219 206 78
Murska 
Sobota
43% 46% 43% 39% 37% 86 316 318 296 267 244 77
Nova 
Gorica
43% 39% 34% 33% 29% 67 242 198 170 159 144 59
Novo 
mesto
47% 45% 44% 43% 42% 89 297 266 259 251 237 80
Ravne na 
Koroškem
44% 44% 41% 40% 41% 93 273 265 236 222 228 84
The indicator shows the share of chil-
dren who were prescribed a second dose 
of an antibiotic (ATC: J01) within 14 days. 
It is not defined whether this is the same 
or a different antibiotic. The indicator has 
improved across all RUs. While in one RU 
a quarter of children receive a repeat dose 
of an antibiotic after the first prescription, 
in some RUs this share is at only one sixth. 
This points to significant differences in 
therapy (Table 6).
The highest share of people who re-
ceived at least one prescription for med-
icines for systemic treatment of bacterial 
infections was in the Murska Sobota re-
gional unit (RU HIIS), 35%. This was fol-
lowed by RU Krško with 34.1%, RU Ravne 
na Koroškem with 33.2%, and RU Novo 
Mesto with 32%. The fewest people re-
ceived drugs at RU Nova Gorica – 21.1% 
(Figure 1).
Table 6: Indicator KK7p – share of use (in DDD) of medicines for systemic treatment of bacterial infections among all 
prescribed medicines, and indicator KK8p – share of people who were prescribed another dose of medicines for systemic 
treatment of bacterial infections in the 2014–2018 period in Slovenia and by RU HIIS with corresponding indices.
Indicator KK7p – share of use (in DDD) of medicines for 
systemic treatment of bacterial infections among all 
prescribed drugs
Indicator KK8p – share of people who received a repeat 
prescription for medicines for systemic treatment of 
bacterial infections
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 12% 12% 12% 11% 10% 84 20% 20% 19% 18% 17% 88
Celje 12% 12% 11% 12% 11% 86 23% 22% 22% 21% 19% 84
Koper 12% 12% 12% 12% 11% 89 22% 20% 21% 19% 17% 76
Krško 9% 10% 11% 10% 10% 105 27% 27% 27% 25% 26% 98
Kranj 12% 11% 11% 11% 10% 87 15% 15% 16% 15% 15% 97
Ljubljana 13% 13% 12% 11% 10% 77 17% 16% 15% 15% 15% 90
Maribor 12% 13% 13% 12% 10% 84 20% 21% 20% 19% 18% 89
Murska 
Sobota
10% 13% 12% 11% 11% 102 24% 25% 24% 23% 19% 81
Nova 
Gorica
10% 9% 8% 7% 6% 56 22% 19% 17% 17% 16% 73
Novo 
mesto
12% 11% 12% 12% 11% 95 24% 23% 22% 23% 21% 86
Ravne na 
Koroškem
14% 15% 13% 13% 13% 92 26% 26% 23% 21% 21% 83
Figure 1: Share of people who received at least one prescription for 
medicines for systemic treatment of bacterial infections by individual 
RU HIIS in 2018.
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Quality indicators of prescribed pediatrics medicines
The indicator shows the share of chil-
dren who were prescribed a second dose 
of an antibiotic (ATC: J01) within 14 days. 
It is not defined whether this is the same 
or a different antibiotic. The indicator has 
improved across all RUs. While in one RU 
a quarter of children receive a repeat dose 
of an antibiotic after the first prescription, 
in some RUs this share is at only one sixth. 
This points to significant differences in 
therapy (Table 6).
The highest share of people who re-
ceived at least one prescription for med-
icines for systemic treatment of bacterial 
infections was in the Murska Sobota re-
gional unit (RU HIIS), 35%. This was fol-
lowed by RU Krško with 34.1%, RU Ravne 
na Koroškem with 33.2%, and RU Novo 
Mesto with 32%. The fewest people re-
ceived drugs at RU Nova Gorica – 21.1% 
(Figure 1).
Table 6: Indicator KK7p – share of use (in DDD) of medicines for systemic treatment of bacterial infections among all 
prescribed medicines, and indicator KK8p – share of people who were prescribed another dose of medicines for systemic 
treatment of bacterial infections in the 2014–2018 period in Slovenia and by RU HIIS with corresponding indices.
Indicator KK7p – share of use (in DDD) of medicines for 
systemic treatment of bacterial infections among all 
prescribed drugs
Indicator KK8p – share of people who received a repeat 
prescription for medicines for systemic treatment of 
bacterial infections
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 12% 12% 12% 11% 10% 84 20% 20% 19% 18% 17% 88
Celje 12% 12% 11% 12% 11% 86 23% 22% 22% 21% 19% 84
Koper 12% 12% 12% 12% 11% 89 22% 20% 21% 19% 17% 76
Krško 9% 10% 11% 10% 10% 105 27% 27% 27% 25% 26% 98
Kranj 12% 11% 11% 11% 10% 87 15% 15% 16% 15% 15% 97
Ljubljana 13% 13% 12% 11% 10% 77 17% 16% 15% 15% 15% 90
Maribor 12% 13% 13% 12% 10% 84 20% 21% 20% 19% 18% 89
Murska 
Sobota
10% 13% 12% 11% 11% 102 24% 25% 24% 23% 19% 81
Nova 
Gorica
10% 9% 8% 7% 6% 56 22% 19% 17% 17% 16% 73
Novo 
mesto
12% 11% 12% 12% 11% 95 24% 23% 22% 23% 21% 86
Ravne na 
Koroškem
14% 15% 13% 13% 13% 92 26% 26% 23% 21% 21% 83
Figure 1: Share of people who received at least one prescription for 
medicines for systemic treatment of bacterial infections by individual 
RU HIIS in 2018.
The highest share of people aged be-
tween 0 and 19 with at least one prescrip-
tion in the year was in the Lendava munici-
pality (46.33%), followed by municipalities 
Turnišče (45.76%), Dobrovnik (43.55%), 
Muta (43.00%), Dobje (41.89%), Središče 
ob Dravi (41.27%), Kobilje (40.91%) and 
Trnovska vas (40.72%) (Figure 2).
KK9p – share of use (in DDD) of broad 
and narrow spectrum medicines for sys-
temic treatment of bacterial infections
The indicator shows the share of use, 
expressed in the number of DDD broad 
and narrow spectrum antibiotics from 
ATC group J01. Broad spectrum anti-
biotics are defined as: amoxicillin with 
clavulanic acid, 2nd and 3rd generation 
cephalosporins, clarithromycin and azith-
romycin. Narrow spectrum antibiotics are: 
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phenoxymethylpenicillin, 1st generation 
cephalosporins, erythromycin, mideca-
mycin, and miocamycin.
Results above 1 show a greater use of 
broad-spectrum antibiotics, and thereby a 
worse, less favourable share. The indicator 
has improved across most RUs, as well as 
at the country level (Table 7).
KK10p – share of use (in DDD) of amox-
icillin and amoxicillin/clavulanic acid
The indicator shows the ratio between 
the DDD numbers of amoxicillin and 
amoxicillin with clavulanic acid. Higher 
results point to a better, i.e., more favour-
able ratio for amoxicillin. The indica-
tor at the level of Slovenia has improved 
throughout this period (index 123) and 
has decreased only in two RUs (RU Nova 
Gorica and RU Ravne na Koroškem). This 
Figure 2: Share of people who received at least one prescription for 
medicines for systemic treatment of bacterial infections by Slovenian 
municipalities in 2018.
points to major differences between RU 
of HIIS. The best improvement is shown 
at RU Celje (index of 166), and RU Krško 
(index of 157) (Table 7).
3.4 Prescribing antibiotics or 
chemotherapy medicines for 
local therapy
KK11p – share of people who received 
an antibiotic or a chemotherapy drug for 
local therapy and the KK12p indicator.
The indicator shows the share of pre-
scription recipients for antibiotics or che-
motherapy drugs for local therapy among 
all prescription recipients and is compa-
rable to KK5p. While 35% of children re-
ceived prescriptions for a systemic antibi-
otic (Table 6), 23% of them received a local 
one (Table 8). As the indicator for system-
Table 7: Indicator KK9p – share of use (in DDD) of broad and narrow spectrum medicines for systemic treatment of 
bacterial infections, and indicator KK10p – share of use (in DDD) of amoxicillin and amoxicillin/clavulanic acid in the 
2014–2018 period in Slovenia and in RU HIIS with corresponding indices.
KK9p – share of use (in DDD) of broad and narrow 
spectrum medicines for systemic treatment of 
bacterial infections
KK10p – share of use (in DDD) of amoxicillin and 
amoxicillin/clavulanic acid
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 0.9 0.8 0.7 0.7 0.7 76 2 2 2.1 2.3 2.4 123
Celje 0.9 0.7 0.6 0.6 0.6 61 2.3 2.2 2.6 3.9 3.8 166
Koper 1.2 1.4 1 1.5 1.2 99 1.1 1.1 1.3 1.3 1.3 124
Krško 1.2 1.4 0.9 1.1 1 85 1.7 1.7 1.9 2.4 2.6 157
Kranj 0.8 0.8 0.6 0.6 0.6 76 2.1 2.3 2.8 2.7 2.9 143
Ljubljana 0.8 0.8 0.6 0.6 0.6 75 2 1.8 2.1 2.1 2.2 114
Maribor 0.9 0.7 0.6 0.6 0.6 66 2 2 2.4 2.7 2.6 130
Murska 
Sobota
0.9 0.6 0.6 0.7 0.7 81 2.3 2.3 2.4 3.1 3.1 135
Nova 
Gorica
0.6 0.6 0.5 0.5 0.7 108 3.8 2.8 2.7 2.9 2.8 74
Novo 
mesto
1.2 1.1 0.9 0.9 0.7 58 1.6 1.8 1.6 1.7 2.3 146
Ravne na 
Koroškem
0.8 0.9 0.8 0.8 0.8 92 2.6 2.7 2.9 3.1 2.4 91
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Quality indicators of prescribed pediatrics medicines
points to major differences between RU 
of HIIS. The best improvement is shown 
at RU Celje (index of 166), and RU Krško 
(index of 157) (Table 7).
3.4 Prescribing antibiotics or 
chemotherapy medicines for 
local therapy
KK11p – share of people who received 
an antibiotic or a chemotherapy drug for 
local therapy and the KK12p indicator.
The indicator shows the share of pre-
scription recipients for antibiotics or che-
motherapy drugs for local therapy among 
all prescription recipients and is compa-
rable to KK5p. While 35% of children re-
ceived prescriptions for a systemic antibi-
otic (Table 6), 23% of them received a local 
one (Table 8). As the indicator for system-
Table 7: Indicator KK9p – share of use (in DDD) of broad and narrow spectrum medicines for systemic treatment of 
bacterial infections, and indicator KK10p – share of use (in DDD) of amoxicillin and amoxicillin/clavulanic acid in the 
2014–2018 period in Slovenia and in RU HIIS with corresponding indices.
KK9p – share of use (in DDD) of broad and narrow 
spectrum medicines for systemic treatment of 
bacterial infections
KK10p – share of use (in DDD) of amoxicillin and 
amoxicillin/clavulanic acid
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 0.9 0.8 0.7 0.7 0.7 76 2 2 2.1 2.3 2.4 123
Celje 0.9 0.7 0.6 0.6 0.6 61 2.3 2.2 2.6 3.9 3.8 166
Koper 1.2 1.4 1 1.5 1.2 99 1.1 1.1 1.3 1.3 1.3 124
Krško 1.2 1.4 0.9 1.1 1 85 1.7 1.7 1.9 2.4 2.6 157
Kranj 0.8 0.8 0.6 0.6 0.6 76 2.1 2.3 2.8 2.7 2.9 143
Ljubljana 0.8 0.8 0.6 0.6 0.6 75 2 1.8 2.1 2.1 2.2 114
Maribor 0.9 0.7 0.6 0.6 0.6 66 2 2 2.4 2.7 2.6 130
Murska 
Sobota
0.9 0.6 0.6 0.7 0.7 81 2.3 2.3 2.4 3.1 3.1 135
Nova 
Gorica
0.6 0.6 0.5 0.5 0.7 108 3.8 2.8 2.7 2.9 2.8 74
Novo 
mesto
1.2 1.1 0.9 0.9 0.7 58 1.6 1.8 1.6 1.7 2.3 146
Ravne na 
Koroškem
0.8 0.9 0.8 0.8 0.8 92 2.6 2.7 2.9 3.1 2.4 91
ic antibiotics has improved, the latter has 
worsened at the state-level by 2% over the 
past 5 years, while significantly improving 
in some RUs.
KK12p – age-standardised level of de-
fined people (number/1000 people) who 
received antibiotic or chemotherapy 
medicines for local therapy, among all 
defined
The data shows the number of defined 
recipients of antibiotics or chemotherapy 
drugs for local therapy per 1000 defined 
children. When defining the population 
of recipients, we took into account the age 
structure of recipients, same as with the 
indicator KK6p. While 186 standardised 
children per 1000 defined received a sys-
temic antibiotic (Table 6), 134 received a 
local one (Table 6). An improvement in 
the sense of reducing the number of re-
Table 8: Indicator KK11p – share of people who received an antibiotic or a chemotherapy medicines for local therapy, 
and indicator KK12p – age-standardised level of defined people (number/1000 people) who received medicines for 
systemic treatment for local therapy, among all defined in the 2014–2018 period in Slovenia and by RU HIIS with 
corresponding indices.
Indicator KK11p – share of people who received an 
antibiotic or a chemotherapy medicines for local 
therapy and the KK12p indicator
Indicator KK12p – age-standardised level of defined 
people (number/1000 people) who received antibiotic 
or chemotherapy medicines for local therapy
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 22% 23% 22% 24% 23% 102 140 141 132 140 134 95
Celje 19% 19% 18% 19% 18% 96 110 111 103 109 98 89
Koper 28% 29% 28% 31% 32% 114 192 187 175 192 192 100
Krško 22% 26% 24% 26% 29% 132 157 188 177 185 201 128
Kranj 23% 23% 21% 24% 22% 95 122 123 113 126 120 98
Ljubljana 22% 23% 22% 24% 23% 103 132 131 124 133 129 97
Maribor 18% 20% 19% 20% 19% 108 127 135 127 128 128 100
Murska 
Sobota
28% 31% 30% 32% 28% 100 217 226 221 229 204 94
Nova 
Gorica
24% 24% 21% 20% 17% 70 140 124 107 100 86 61
Novo 
mesto
19% 19% 19% 20% 18% 96 143 138 131 136 120 84
Ravne na 
Koroškem
25% 26% 24% 26% 24% 93 162 158 137 145 135 84
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cipients is significantly more expressed in 
systemic antibiotics, where the differences 
among RUs are also smaller.
KK13p – share of people who received a 
second dose of an antibiotic or a chemo-
therapy medicine for local therapy
The indicator shows the share of chil-
dren who were prescribed a repeated dose 
of an antibiotic or a chemotherapy medi-
cine for local therapy (Table 9). The share 
in 2018 is on average the same as with sys-
temic antibiotics (Table 9). This indicator 
also shows major differences between RUs.
KK14p – share of use (in packs) of an-
tibiotics or chemotherapy medicine for 
local therapy among all antibiotics
The indicator shows the use of antibiot-
ics or chemotherapy drugs for local thera-
py among all antibiotics; use was measured 
in packs (Table 9). The share has increased 
in most RUs in the past years, pointing to 
an effective decrease of systemic and local 
antibiotics.
4 Discussion
The 14 indicators described provide 
a broad insight into drug prescribing to 
children. While standardisation by age 
structure of children is not as important 
for comparisons between RUs, it is very 
important for comparisons between pop-
ulations of defined children of individual 
physicians. A comparison of a physician 
working at a preschool outpatient clin-
ic with one who only treats school-going 
children would not make sense without a 
standardisation.
The index of the number of issued 
prescriptions to children in the years 
2014–2018 in Slovenia was lower by 3%, 
while in the same period there were 9% 
more DDD prescribed. The highest share 
of persons who received at least one pre-
Table 9: Indicator KK13p – share of people who received a prescribed antibiotic or chemotherapy medicine for local 
therapy, and indicator KK14p – share of use (in packs) of antibiotics or chemotherapy medicine for local therapy among 
all antibiotics in the 2014–2018 period in Slovenia and by RU HIIS with corresponding indices.
KKp13 – share of children with repeat prescriptions of 
local antibiotics
KKp14 – share of use (in packs) of local antibiotics 
among all antibiotics
2014 2015 2016 2017 2018 Index 
2018/2014
2014 2015 2016 2017 2018 Index 
2018/2014
Slovenija 19% 18% 18% 18% 17% 90 36% 38% 38% 41% 41% 113
Celje 15% 15% 15% 15% 13% 88 31% 34% 35% 36% 38% 121
Koper 22% 20% 21% 20% 22% 99 40% 44% 41% 47% 50% 125
Krško 22% 24% 25% 26% 25% 112 36% 40% 38% 44% 45% 123
Kranj 15% 15% 15% 14% 13% 83 40% 40% 38% 42% 40% 100
Ljubljana 17% 16% 16% 16% 15% 90 37% 39% 39% 42% 42% 113
Maribor 20% 20% 19% 18% 17% 86 34% 36% 36% 39% 40% 117
Murska 
Sobota
23% 24% 26% 26% 23% 101 40% 41% 43% 48% 45% 112
Nova 
Gorica
19% 14% 14% 12% 12% 61 36% 38% 39% 39% 38% 107
Novo 
mesto
20% 22% 18% 18% 15% 72 28% 30% 29% 29% 28% 101
Ravne na 
Koroškem
21% 20% 19% 19% 17% 84 37% 37% 38% 41% 38% 104
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Quality indicators of prescribed pediatrics medicines
scription for drugs for systemic treatment 
of bacterial infections was at RU Murska 
Sobota, namely 35%. This was followed 
by RU Krško with 34.1%, RU Ravne na 
Koroškem with 33.2%, and RU Novo Mes-
to with 32%. The fewest people received 
drugs at RU Nova Gorica – 21.1%.
The five-year period provides an in-
sight into the dynamics of changes at the 
level of Slovenia, any by individual RUs. At 
the level of Slovenia, three out of four gen-
eral indicators were improved, with only 
decline in KK3p – the age-standardised 
DDD number of prescribed medicines 
per standardised recipient. All six antibi-
otic indicators for systemic therapy have 
improved, which is a very significant re-
sult. The results of indicators of antibiot-
ics or chemotherapy drugs for local ther-
apy show that two decreased, namely the 
share of people who received an antibiotic 
or a chemotherapy drug for local therapy 
(KK11p) and the age-standardised level 
of defined people (number/1000 people) 
who received antibiotic or chemotherapy 
drugs for local therapy, among all defined 
(KK12p). Two indicators, the share of 
people who received a prescribed antibiot-
ic or chemotherapy drug for local therapy 
(KK13p), and the share of use (in packs) of 
antibiotics or chemotherapy drugs for lo-
cal therapy among all antibiotics (KK14p) 
have improved. The share of children who 
were prescribed a second dose of a local 
antibiotic within 14 days in 2018 is on av-
erage the same as with systemic antibiotics 
(Table 9), with major differences between 
RUs. The share has decreased in most RUs 
in the past years, pointing to an effective 
decrease of prescribing both systemic and 
local antibiotics.
Comparisons between RUs paint a very 
diverse picture. A highly simplified ap-
proach for assessing the success of an in-
dividual RU is by looking at the number 
of derogations of individual RUs in indica-
tors from the average by more or less than 
20% in 2018, we can see that the deroga-
tions below 20%, which are marked green, 
and the derogations above 20%, which are 
marked red, for the RUs listed below. The 
data has been collected from all indicators 
(Table 10).
The presented indicators cannot be put 
directly into international context. The ra-
tion between broad and narrow spectrum 
antibiotics is one of the indicators of the 
European Centre for Disease Prevention 
and Control (ESAC-net), published on its 
website for whole populations of includ-
ed countries (12). Sandra de Bie et al. has 
published the data of this indicator for 
the paediatric population for the 2001–
2010 period (4). In 2010, the ratio for the 
Netherlands stood at 3.2, for the United 
Kingdom at 0.3 and for Italy at 217.9. For 
Slovenia, this ratio stood at 0.9 in 2014, 
and in 2018, it improved to 0.7 (Table 7, 
indicator KK9p). The comparison shows 
that according to this indicator, Slovenia is 
very far behind the United Kingdom, but 
still better than the Netherlands and Italy. 
It naturally has to be taken into account 
that there is a 4-year difference between 
the data.
We also calculated the A/B indicator 
for the Slovenian paediatric population, 
developed by the same working group. It 
Table 10: RU HIIS, listed by number of 
derogations from the Slovenian average 
by less (green) or more (red) than 20% per 
individual indicator. 
Green Red
Nova Gorica 6 1
Celje 3 1
Kranj 2 0
Novo mesto 1 1
Murska Sobota 1 6
Ljubljana 0 0
Maribor 0 0
Ravne na Koroškem 0 3
Koper 0 6
Krško 0 9
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shows the ratio between number of peo-
ple who received amoxicillin, and the 
number of people who received broad 
spectrum antibiotics from the groups 
ATC J01CR (penicillin combined with 
β-lactamase inhibitors), J01DC (2nd gen-
eration cephalosporins), J01DD (3rd gen-
eration cephalosporins) and J01F (mac-
rolides, lincosamides and streptogramins 
without erythromycin, miocamycin and 
midecamycin) (4). The value of the indi-
cator in 2014 was 0.93, and in 2018, it was 
0.75, which is a 19% decrease (Table 11). 
In 2010, this ratio in Italy stood at 0.3, in 
the Netherlands at 1.6, and in the United 
Kingdom at 5.4. For this indicator, it also 
applies that because of the 4-year differ-
ence, the comparison can only serve as an 
orientation; however, it does point to a sig-
nificantly poorer ratio in Slovenia than in 
the United Kingdom and the Netherlands.
For a comprehensive assessment of in-
dicators, their shortcomings also have to 
be known. Indicators do not differentiate 
physicians by their specialisation. The 
only measure for including a physician is 
the number of defined children. The da-
ta shows that the defined paediatric pop-
ulations of physicians are very different. 
The range in the number of standardised 
children is between 101 and 2,019, and the 
range of consultation rate is between 102 
and 3,697. Younger physicians do not yet 
have all the defined children, even though 
they are perhaps already their patients, 
data from job changes are delayed. The 
Table 11: The number of people aged 19 years 
or less in Slovenia who received prescriptions 
for medications from the listed ATC groups 
of drugs between 2014 and 2018 and the A/B 
indicator.
ATC Group 2014 2018
J01CA04 62.705 52.661
J01CR+DC+DD+F 58.157 39.733
A/B indicator 0,93 0,75
indicators do not take into account the so-
cial aspect. Despite its small size, Slovenia 
is a socially very diverse country, which 
is also reflected in children morbidity. 
Comparisons between RUs and the der-
ogations from the average does not take 
into account that RUs have very different 
population numbers. Positive derogation 
in a small RU may be the result of a high 
quality of the work of a smaller group of 
physicians, while change in a large RU re-
quires the engagement of a significantly 
bigger number of physicians.
A more detailed monitoring of different 
aspects of antibiotic use with children was 
the most important reason for introducing 
indicators, as physicians often prescribe 
antibiotic especially for infections of the 
upper respiratory tract. Excessive use and 
inappropriate prescription of antibiotics 
results in resistance to them (13,14). In It-
aly, nearly a half of paediatricians (44.5%) 
demonstrated insufficient quality in pre-
scribing antibiotics (15).
Presented indicators point to an im-
provement in the quality of prescribing 
drugs to children, especially in the field 
of antibiotics for systemic therapy. We 
believe that the indicators are useful both 
for individual physicians and for deci-
sion-making at the national level. They 
can contribute to continued management 
of the use of antimicrobial drugs, which is 
their core purpose (16).
In November 2017, HIIS sent the 
guidelines for treating the most frequent 
infections to all physicians together with 
the Recept (Prescription) publication. The 
objective of this review is not a statistical 
analysis of their impact to prescriptions or 
indicators. This would be difficult to eval-
uate. The dynamics of antibiotic indicators 
shows that in 2018 the positive trend from 
the previous years has continued. This has 
achieved the purpose of these guidelines. 
The group of authors who described the 
approaches to managing antibiotics in 
Slovenia has discovered that successful 
management requires a comprehensive 
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REVIEW ARTICLE
Quality indicators of prescribed pediatrics medicines
approach from several perspectives (16). 
Guidelines and indicators certainly con-
tribute towards better management of an-
timicrobial drugs use.
5 Conclusion
Slovenia is one of the few countries to 
establish indicators for prescribing medi-
cines in paediatrics in primary healthcare. 
A review of the 2014–2018 period shows 
an improvement in indicators, especially 
in the prescribing of antibiotics for sys-
temic treatment of bacterial infections. 
The improvement is less expressed in the 
field of prescribing antibiotics or chemo-
therapy drugs for local therapy. Orienta-
tion comparison with the published data 
for the United Kingdom, the Netherlands 
and Italy shows that especially United 
Kingdom has significantly better indica-
tors than Slovenia. All of this shows that 
we should strive towards improvement – 
continued reduction of the use of antibiot-
ics and the change in the structure towards 
narrow spectrum antibiotics.
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