{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:04:03Z","timestamp":1792047843559,"version":"4.4.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antimicrobial resistance is driven by inappropriate antibiotic use, and T\u00fcrkiye has long shown one of the highest outpatient consumption rates in the WHO European Region. In response, the Ministry of Health implemented stewardship measures from 2014 onward, including the National Action Plan for Rational Drug Use, banning over-the-counter antibiotic sales, integrating e-prescribing with mandatory diagnostic coding, educational initiatives, and audit-feedback systems. This study evaluated temporal trends in primary care antibiotic prescribing in T\u00fcrkiye between 2011 and 2019 and assessed the influence of these interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a nationwide descriptive analysis using aggregated Prescription Information System (RBS) data covering all family-physician prescriptions (2011\u20132019). Outcomes included: (i) proportion of prescriptions containing systemic antibiotics (ATC J01), (ii) consumption in DID, (iii) use by ATC-3 class and AWaRe category, (iv) antibiotic share of drug volume and cost, and (v) patterns by age, sex, and diagnosis. Trends were summarized using annual percentages and DID values. The two pre-specified primary outcomes were the annual antibiotic prescription rate and total systemic antibiotic consumption (DID, ATC J01); other indicators were treated as secondary. Because the RBS captures only e-prescribed antibiotics, over-the-counter sales (legal in T\u00fcrkiye until 2016) are not included. Segmented (interrupted time-series) regression with Newey\u2013West HAC standard errors was applied to test for changes in level and slope at 2016, when prescription-only dispensing was fully enforced and mandatory ICD-10 coding was consolidated within the e-prescribing system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1.17 billion prescriptions, the share containing an antibiotic declined from 34.9 to 23.9%, while consumption fell from 42.3 to 31.9 DID (\u221225%). Beta-lactams showed the largest reductions, though Watch-group agents still formed nearly half of use in 2019, below the WHO \u226560% Access target. Pediatric prescribing decreased most: use in children aged 0\u20136\u202fyears dropped from 60 to 44% of visits. Elderly patients had the lowest rates. Diagnostic coding shifted away from nonspecific upper-respiratory infections. Antibiotics\u2019 share of outpatient drug costs fell from 10.7 to 4.7%, yielding an estimated 1.7 billion TL savings in 2018. Segmented regression confirmed an acceleration of the decline after 2016: the slope changed by \u22120.69 percentage points\/year for the prescription rate (95% CI\u202f\u2212\u202f1.44 to +0.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.07) and by \u22120.80 DID\/year for total consumption (95% CI\u202f\u2212\u202f0.88 to \u22120.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) versus the pre-2016 trajectory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>T\u00fcrkiye achieved major reductions in primary care antibiotic use within a decade, temporally concordant with multifaceted stewardship policies whose individual contributions cannot be isolated by this descriptive design. However, outpatient levels remain above many EU countries, and Watch-group use is still high. Further progress requires stronger guideline adherence, prioritization of Access antibiotics, and wider use of point-of-care diagnostics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1762561","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:09:39Z","timestamp":1779430179000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Trends in primary care antibiotic prescribing during the implementation of national stewardship policies: T\u00fcrkiye, 2011\u20132019"],"prefix":"10.3389","volume":"17","author":[{"given":"Hakk\u0131","family":"\u00d6zt\u00fcrk","sequence":"first","affiliation":[{"name":"Afyonkarahisar Provincial Health Directorate","place":["Afyonkarahisar, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bircan","family":"Kayaaslan","sequence":"additional","affiliation":[{"name":"Department of Infection Diseases and Clinical Microbiology, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t \u00dcniversitesi, Ankara Bilkent \u015eehir Hastanesi","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1298858","DOI":"10.3389\/fmicb.2023.1298858","article-title":"WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance\u2014a descriptive study from an English NHS foundation trust prior to and during the COVID-19 pandemic","volume":"14","author":"Abdelsalam Elshenawy","year":"2023","journal-title":"Front. Microbiol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/pds.5311","article-title":"Evaluation of more than one billion outpatient prescriptions and eight-year trend showing a remarkable reduction in antibiotic prescription in Turkey: a success model of governmental interventions at national level","volume":"30","author":"Aksoy","year":"2021","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"169","DOI":"10.31086\/tjgeri.2020.151","article-title":"Polypharmacy prevalence among geriatric patients in primary healthcare settings across Turkey: a cross-sectional analysis through the Nationwide Prescription Information System","volume":"23","author":"Aydos","year":"2020","journal-title":"T\u00fcrk Geriatri Dergisi."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"134","DOI":"10.36519\/idcm.2019.19025","article-title":"Public knowledge and attitudes regarding antibiotic use in Ankara, Turkey","volume":"3","author":"Azap","year":"2019","journal-title":"Infect. Dis. Clin. 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World Health Organ."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"791","DOI":"10.3390\/antibiotics11060791","article-title":"Effectiveness of educational interventions for health workers on antibiotic prescribing in outpatient settings in China: a systematic review and meta-analysis","volume":"11","author":"Zheng","year":"2022","journal-title":"Antibiotics (Basel)."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1762561\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T06:09:43Z","timestamp":1779430183000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1762561\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":56,"alternative-id":["10.3389\/fmicb.2026.1762561"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1762561","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"1762561"}}