Less and more appropriate antibiotic use needed to reduce antibiotic resistance
In the community, i.e. outside of hospitals, the emergence and spread of antibiotic-resistant bacteria is mainly driven by the inappropriate use of antibiotics. As part of series of scientific articles published by the Journal of Antimicrobial Chemotherapy, researchers from the University of Antwerp and Hasselt University, experts from the European Centre for Disease Prevention and Control (ECDC) and contributing experts from EU/EEA countries provide the most comprehensive and detailed description to date of antibiotic consumption in the community in Europe and identify numerous areas where antibiotic use could be improved.
The large differences in community antibiotic consumption among EU/EEA countries, as reported in 1997, were still evident in 2017, based on data from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) covering that period. Despite the success of some EU/EEA countries in tackling antibiotic consumption individually, there was no significant decrease in community antibiotic consumption in the EU/EEA overall. In addition, there remained large seasonal variations, which are usually associated with inappropriate use for self-limiting viral infections during the winter season. For penicillins, the most commonly consumed group of antibiotics in the community, there was a shift from narrow-spectrum to broad-spectrum penicillins. For quinolones - all of which are listed in WHO’s Watch group of antibiotics, seasonal variation increased.
Unsurprisingly, the overall quality of antibiotic use in the community as measured by quality indicators decreased. Such quality indicators include, for example, total community antibiotic consumption, its seasonal variation, the ratio of broad- to narrow-spectrum antibiotics and the seasonal variation of quinolones. All these issues represent opportunities to improve antibiotic use in the community.
“Antibiotics play a key role in the treatment of bacterial infections. Over time, their overuse and misuse have led to antibiotic resistance, a major public health threat, resulting in treatment failures, increased costs of care and increased mortality of patients with antibiotic-resistant infections. Trustworthy information on antibiotic consumption is an essential resource in the fight against antibiotic resistance to inform antimicrobial stewardship activities, set targets for the use of specific antibiotic groups and monitor adherence to national guidelines” the authors said.
As part of this series of scientific articles, the authors also provide statistical tools and a tutorial to help the ESAC-Net participating countries to evaluate the impact of regulatory changes, public awareness campaigns, and other national interventions to improve antibiotic use in the community in the EU/EEA.
Note to the editors:
In 2001, a European network of national surveillance systems collecting comparable and reliable data on antimicrobial consumption—the European Surveillance of Antimicrobial Consumption (ESAC) project, coordinated by the University of Antwerp—was launched to accompany analogous surveillance on antimicrobial resistance. By 2009, the ESAC project had expanded to 35 European countries, and in 2011, ECDC took over the coordination of the collection of data on antimicrobial consumption under the European Surveillance of Antimicrobial Consumption Network (ESAC-Net), focusing on countries in the European Union and European Economic Area (EU/EEA). ESAC-Net data are publicly accessible from an interactive database as well as annual reports.
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