Herman Goossens (University of Antwerp, Belgium) and colleagues compared antibiotic use with antibiotic resistance rates in 26 European countries from the beginning of 1997 to the end of 2002. To control for the different population sizes the investigators expressed data in defined daily dose per 1000 inhabitants daily (DID).
The study found that the prescription of antibiotics in primary care in Europe vary greatly. The highest rate was in France (32.2 DID) and the lowest was in the Netherlands (10.0 DID). Across Europe antibiotic use was lower in northern, moderate in eastern and higher in southern regions. Seasonal fluctuations were high in southern and eastern European countries, whereas in northern European countries the increase in antibiotic use during the winter was less than 25%. In most countries the researchers found a growing use of the newer antibiotics (active against a broad spectrum of micro-organisms) and a decline in use of the older antibiotics (active against a narrow spectrum of micro-organisms).
The authors believe the data will be useful for assessing public health strategies that aim to reduce inappropriate antibiotic use and resistance levels. In the article they write that the differences in antibiotic use between countries might be explained by variations in incidence of community infections, culture and education, differences in drug relations and in the structure of the national pharmaceutical market.
Professor Goossens concludes: "Population-based studies are needed to determine the motivation and incentives that lead individuals to use or not to use antibiotics. The ethics of promoting antibiotics in clinical situations in which they are unnecessary should be given serious consideration. In
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