This retrospective claims study evaluated real-world antibiotic prescribing patterns among privately insured beneficiaries (Daman) in Saudi Arabia to inform stewardship and policy. The analysis aimed to quantify prescribing volume, link prescriptions to clinical indications, benchmark consumption against international standards, examine prescriber specialties and demographic patterns, measure treatment duration, and assess appropriateness for respiratory tract infections using established metrics.
The study was a retrospective analysis of deidentified health insurance claims drawn from the National Platform for Health and Insurance Exchange Services (NPHIES). The observation window covered 1 November 2023 through 31 October 2024. Antibiotic prescriptions were identified within claims records and subsequently mapped to the Saudi Food and Drug Authority (SFDA) drug list for classification.
Antibiotic claims were linked to diagnostic codes using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) to determine the clinical indication for each prescription. This linkage enabled the investigators to evaluate prescribing by diagnosis, including respiratory tract infections, and to apply standard appropriateness measures.
Among 4.02 million claimants recorded in the dataset, a total of 8.3 million antibiotic prescriptions were identified during the 12-month study period. Prescription data were stratified by patient age and sex, and by prescriber specialty, to examine patterns across subgroups.
Key metrics reported in the analysis included:
Age- and sex-stratified analyses demonstrated notably high antibiotic prescription rates in certain male subgroups. Male infants had a prescription rate of 509.6 per 1000, and older males had 641.9 prescriptions per 1000. Prescribing was dominated by general practitioners, who accounted for 80% of antibiotic prescriptions in the claims dataset.
Broad-spectrum beta-lactams were the most frequently prescribed antibiotic class, with amoxicillin - clavulanate specifically highlighted as predominant. The study reported overall antibiotic consumption of 11.63 DDD per 1000 insured persons per day, a figure the authors compared to European Surveillance of Antimicrobial Consumption Network (ESAC-Net) outpatient benchmarks and found to be comparable.
Mean reported treatment durations ranged from 8 to 14 days. The authors noted these durations exceed commonly recommended durations for many community and outpatient infections and therefore fall outside typical antimicrobial stewardship expectations.
Appropriateness of prescribing for respiratory tract infections was evaluated using HEDIS metrics. The assessment identified overprescribing, particularly for upper respiratory tract infections, indicating that a proportion of antibiotic use in these conditions did not align with HEDIS-based appropriateness criteria.
This analysis represents the first claim-based evaluation of antibiotic prescribing among Daman beneficiaries in Saudi Arabia reported by the authors. Key conclusions drawn from the claims data include the predominance of broad-spectrum agents (especially amoxicillin - clavulanate), high prescribing rates in specific male age groups, long mean treatment durations, and evidence of overprescribing for respiratory tract infections per HEDIS indicators.
To address these issues, the authors proposed interventions aimed at optimizing prescribing, reducing antimicrobial resistance (AMR) risk, and informing policy. Suggested measures included implementation of clinical decision support systems, artificial intelligence–driven audits, and targeted education for prescribers.
The source article text does not provide detailed limitations beyond the scope described above. Specific methodological details such as the five selected inpatient antibiotics by name, full breakdown of DDDs for each agent, granular diagnostic categories beyond respiratory tract infections, and statistical measures (confidence intervals, significance testing) were not reported in the provided summary. Where the source did not report further methodological or limitation details, those specifics are not inferred.