The Pharmaceutical Journal
Vol 274 No 7337 p199
19 February 2005

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Antibiotic resistance in Europe lowest in the north

Antibiotic resistance is less common in northern Europe than it is in southern or eastern Europe, probably because antibiotics are used less widely in the north.

So suggests new research from the European Surveillance of Antimicrobial Consumption management team in Belgium. Researchers compared the extent of antibiotic prescribing in primary care in 26 European countries by calculating the defined daily dose (DDD) of antibiotic per inhabitant. This was compared with levels of antibiotic resistance in each country.

The researchers found that outpatient antibiotic use was lower in northern European countries than in the rest of Europe. The highest rate was seen in France (32.2 DDD) and the lowest rate was in the Netherlands (10 DDD). The UK rate was about 14 DDD. Seasonal fluctuations were also found to be lower in northern European countries compared with southern or eastern Europe.

Furthermore, levels of resistance were found to correspond to levels of antibiotic use. The researchers say that differences in antibiotic use between countries may be explained by variations in the incidence of community-acquired infections, culture and education or differences in drug regulations. They say that these data may be useful for assessing public health strategies aimed at reducing antibiotic use and resistance levels (Lancet 2005;365:579).

Jonathan Cooke, chief pharmacist at South Manchester University Hospitals NHS Trust and chairman of the prescribing sub-group of the Specialist Advisory Committee on Antimicrobial Resistance commented: “The message appears to be that those countries that use fewer antibiotics have fewer resistance problems. However, cause and effect will only be confirmed when individual patient records are linked to prescribing, diagnostic and surveillance data.”

He said that the new research should encourage the continuation of programmes that promote the rational use of antimicrobials in acute NHS hospitals. “In the UK, primary care antimicrobial consumption has continued to fall year on year for the past six years”, he said. “This might be due to increased patient and prescriber awareness from the public health campaigns as well as media interest in the subject.” He added: “Pharmacists in primary care have an important public health role in this respect and the new contract should enable their skills and influence to be effectively employed.”