PRESCRIPTIONS/1,000 INHABITANTS AND YEAR

3. PRESCRIPTIONS/1,000 INHABITANTS AND YEAR

3.1. European Union

Information on the number of prescriptions was obtained for Austria, Belgium, Finland, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, and the UK from IMS (Mölstad et al., 2002). For Denmark and Sweden information was obtained from the Danish Medicines Agency and the National Corporation of Swedish Pharmacies. Between 1994 and 1997, the number of prescriptions per 1,000 inhabitants increased in France and Greece while Portugal, Spain, and Sweden reported a decrease. In 1997, Greece (1,350), Spain (1,320), and Belgium (1,070) had the highest numbers of antibiotic pre- scriptions per 1,000 inhabitants while the Netherlands (390), Sweden (460), and Austria (480) had the lowest. The most common antibiotics were extended-spectrum penicillins in 6 out of 13 countries, macrolides in Austria, Finland, and Germany, narrow-spectrum penicillins in Denmark and Sweden, and cephalosporins in Greece.

3.2. United States

In a sample survey 2,500–5,000 office-based physicians reported data on office visits between 1980 and 1992 for all ages, including information on antimicrobial drug prescribing (McCaig and Hughes, 1995). From 1980 to 1992, no major change in the frequency of prescriptions for all anti- microbial drugs was registered. However, a relative increase in the number of prescriptions/1,000 inhabitants and year was found for the more expensive, broad-spectrum antimicrobial drugs, such as cephalosporins and decreasing rates were observed for less expensive drugs with narrower-spectrum, such as

Antibiotic Use in the Community 573 penicillins. No trend was found for trimethoprim-sulfamethoxazole, ery-

thromycin, or tetracyclines. In a sample survey between 1992–2000, 1,100–1,900 physicians and 200– 300 outpatient departments provided information on antibiotic prescriptions. Between 1992 and 2000, the number of antimicrobial prescriptions decreased from 151 million to 126 million (McCaig et al., 2002). During the same period the number of physician visits increased slightly from 908 millions to 1.0 billion. Antimicrobial prescriptions declined by 23%, from 599 to 461/1,000 inhabitants and year. The prescribing per visit declined by 25%, from 166 to 125 antimicro- bial drug prescriptions/1,000 visits and year. The decline in prescribing rates var- ied between different age groups and was 32% for patients ⬍15 years of age, 9% in the age group 15–24 years, and 17% for patients 25–44 years of age. No decline was observed in the age group ⬎45.

There was a decrease in the use of amoxicillin/ampicillin, cephalosporins, and erythromycin (⫺43%, ⫺28%, ⫺76%, respectively). Decreasing trends were also found for other penicillins, tetracyclines, and trimethoprim- sulfamethoxazole. There was increase in the use of azithromycin /clarithromycin, quinolones, and amoxicillin/clavulanate (⫹388%, ⫹78%, and ⫹72%, respec- tively). The most often used antibiotics in year 2000 were amoxicillin/ ampi- cillin followed by cephalosporins, azithromycin/clarithromycin, quinolones, and amoxicillin/clavulanate.

3.3. Canada

Data reported by IMS Health, Canada, showed that prescribing of antibi- otics increased steadily in Canada between 1990 and 1995 to reach 27.3 mil- lion (www.imshealthcanada.com). By the end of 1999, the number had decreased between 1990 and 1995 by close to 2 million to 25.5 million. The most commonly dispensed antibiotic, amoxicillin, decreased each year, while second-line antibiotics increased by 23% in 1999. Approximately 800 pre- scriptions per 1,000 inhabitants were dispensed in 1999, but with regional variation between 750 and 1,190 prescriptions per 1,000 inhabitants and year were dispensed.

The Drug Information Network is a prescription database, which reflects drug use for the population in the Canadian province Manitoba. Total use of antibiotics declined by 13.7% between 1995 and 1998 for non-institutionalised population (Carrie et al., 2000). In 1995, 899 prescriptions per 1,000 inhabi- tants were issued, a figure that decreased to 778 in 1997. In 1997, penicillins were the most commonly used class of antibiotics, representing almost 50% of total antibiotic prescriptions, followed by macrolides (8.7%), sulfonamides (12.5%), cephalosporins (8.7%), tetracyclines (5.4%), and fluoroquinolones

574 Sigvard Mölstad and Otto Cars (4%). The most commonly prescribed antibiotics showed a decrease: amoxicillin

⫺17%, erythromycin ⫺29%, trimethoprim-sulfamethoxazole ⫺18.7%, narrow- spectrum penicillins ⫺19.2% and tetracycline ⫺18.9%. Antibiotics used more frequently included ciprofloxacin, ⫹21.9%, cefuroxime ⫹30.7% and azithromycin/clarithromycin ⫹29.5%.

3.4. Australia

Data on dispensed antibiotics were obtained from a database, monitored by the Drug Utilization Sub-Committee (McManus et al., 1997). The database contains information on all subsidised prescriptions together with an estimate of non-subsidised prescriptions from a sample of about 250 community phar- macies. In 1995, amoxicillin, though declining, remained the most dispensed antibiotic followed by amoxicillin ⫹ clavulanate, cefaclor, doxycycline, and cefalexin. The use of quinolones was low (2.2%), most likely because of pre- scribing restrictions. The overall antibiotic pattern in Australia was similar to that in the United Kingdom.