DDD/1,000 INHABITANTS AND DAY (DID)

2. DDD/1,000 INHABITANTS AND DAY (DID)

2.1. Europe

2.1.1. European Union

Data for non-hospital national sales for 1993 and 1997 was obtained for all

15 Members States of the European Union. For 13 countries (Austria, Belgium, Germany, Finland, France, Greece, Italy, Ireland, Luxembourg, Netherlands, Spain, Portugal, and the United Kingdom) from the Institute for Medical Statistics (IMS) and for Sweden and Denmark from the National Corporation of Swedish Pharmacies and the Medical Product Agency, respectively (Cars et al., 2001). IMS collects data from different sources, including wholesalers,

Antibiotic Use in the Community 569 estimates. Data from Sweden and Denmark included all outpatient sales from

community pharmacies. Between 1993 and 1997, large increases were noted in Italy (34%) and Luxembourg (12%), and a reduction was seen in five coun- tries: Sweden had the largest (21%) and Greece the smallest (4%). Total sales of antibiotics in 1997 varied 4-fold between the countries: France (36.5 DID), Spain (32.4 DID), Portugal (28.8 DID), and Belgium (26.7 DID) had the high- est sales, whereas the Netherlands (8.9 DID), Denmark (11.3 DID), Sweden (13.5 DID), and Germany (13.6 DID) had the lowest. In Figure 1, these data were compared with previously published data for France, Australia, United States, Canada, United Kingdom, and West Germany (McManus et al., 1997). There were also profound variations in use of different classes of antibiotics. In 11 of the 15 countries, the most commonly used antibiotics were broad- spectrum penicillin, which varied between 56% (Spain) and 20% (Germany) of total sales. In Finland, the most common drug was a tetracycline (28%), in Austria a macrolide (26%), and in Denmark and Sweden narrow-spectrum penicillins (40% and 36%, respectively).

DDD/1000 inhabitants and day 15

Luxem G e Sw en D G erm

N et herl

Figure 1. Antibiotic consumption in DDD/1,000 inhabitants and day (DID) in 1997 in 15 EU countries (France, Spain, Portugal, Belgium, Luxemburg, Italy, Greece, Finland, Ireland, United Kingdom, Austria, Germany, Sweden, Denmark, and the Netherlands) (Cars et al., 2001) and for France, Australia, United States, Canada, United Kingdom, and West

570 Sigvard Mölstad and Otto Cars

30.00 Other Sulfonamides Quinolones

25.00 Macrolides Tetracyclines Cephalosporins Penicillins

France Greece

CroatiaSloveniaSweden Norway EnglandGermanyDenmark Luxemburg Austria PolandPortugalBelgiu Slovaki Netherlands

FinlandHungary Spai

Czech Republic

United Kingdom

Figure 2. Use of antibiotics in ambulatory care in 2001 according to a retrospective data col- lection by ESAC.

The European Surveillance of Antimicrobial Consumption (ESAC) is a recently created international network of national surveillance systems funded by the European Commission aiming to collect comparable and reliable data on antibiotic consumption in European Countries. The first report showed retrospec- tive data for 1997–2001 from ambulatory care from 21 countries in Europe (www.ua.ac.be/ESAC). Use in Europe remained at a high average level in the par- ticipating countries of about 20 DID for the study period. In 2001, the use varied between 9.2 DID (Netherlands) and 32.9 (France). Finland, Sweden, Norway, Denmark, the Netherlands, and Latvia were low consumers using relatively narrow-spectrum penicillins and tetracyclines more extensively and less cephalosporins and quinolones (Figure 2). Southern European countries (Portugal, Italy, Greece, and France) were high consumers using broad-spectrum penicillins, and exceptionally high proportions of cephalosporins, macrolides, and quinolones.

2.1.2. Nordic countries

In the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) all drugs are distributed through a national network of pharmacies, which

Antibiotic Use in the Community 571

DDD/1000 inhabitants and day

Finland Iceland Norway Sweden

Figure 3. Antibiotic use (hospital and outpatient use) in the Nordic countries in DDD/1,000 inhabitants and day (DID), between 1993 and 2002. For Denmark, 1994–6, only outpatient care was included.

enables a precise follow-up of the amounts of different antibiotics dispensed. Iceland and Finland have the highest use and Denmark the lowest use of antibiotics. The use of antibiotics has remained steady during the last decade, but a decrease has been noted in Sweden between 1993–7 (Swedres, 2002; Figure 3).

2.1.3. Eastern Europe

In 1998, information on used amount of antibiotics was gathered from dif- ferent sources in the respective countries, including pharmaceutical manufac- turers’ offices, pharmaceutical market research companies, and Ministries of Health. The pattern of total antibiotic use (ambulatory and hospital use) in the studied countries varied markedly, from 25.8 DID in Slovakia, 22.5 in Poland,

21.1 in Hungary, 11.2 in Russia, and 8 in Belarus (Stratchounski et al., 2001). Russia and Belarus had a lower level of consumption and used lesser quantities of penicillins, cephalosporins, macrolides, and quinolones but greater amounts of aminoglycosides and chloramphenicol.

572 Sigvard Mölstad and Otto Cars

2.1.4. Australia

Data on sales of oral antibiotics to retail and hospital markets was obtained from a commercial market research organisation, Intercontinental Medical Service, Melbourne. Antibiotic use remained steady between 1990 and 1995, with an estimated 24.7 DID in 1990 and 24.8 DID in 1995 (McManus et al., 1997). Using the same data source, a comparison with France, United States, Canada, United Kingdom, and West Germany was reported. In 1995, France had the highest use, approximately 34 DID, Australia 25, United States 23, Canada 21, United Kingdom 16, and West Germany 11 DID (Figure 1).