Outpatient antimicrobial use in Europe

Antimicrobial resistance poses a threat to public health and has economic implications for society. Concerted action is necessary to contain this problem by encouraging the prudent use of antimicrobial agents in human and veterinary medicine and better hygiene and infection control.;Within the European Surveillance of Antimicrobial Consumption (ESAC) project, we aimed to collect standardised, harmonised and comparable data on outpatient antimicrobial use in human medicine.;Outpatient-antimycotic and antifungal use, and total antiviral use: Analysis showed a striking variation in Europe. There was no statistically significant correlation with outpatient antibiotic use, expressed in Defined Daily Doses (DDD).;Outpatient antibiotic use: Using state-of-the-art statistical methods allowed a detailed analysis of total outpatient antibiotic use and its major subgroups from 1997 to 2009, the trends over time, seasonal variation, and composition of use. The increase in use over time of broad-spectrum antibiotics, such as amoxicillin/clavulanic acid, macrolides and quinolones, has continued. Seasonality of outpatient antibiotic use is observed in all countries. The seasonal variation of outpatient antibiotic use decreased over time, suggesting more appropriate prescribing.;For future surveillance of antimicrobial consumption we propose a combination of outcome measures including DDD and packages (or prescriptions) per 1000 inhabitants per day, as well as information on the number of persons treated. Only a combination of outcome measures provides sufficient information to evaluate national and international antimicrobial consumption, as every single outcome measure has its own advantages and limitations.;Quality of antibiotic use: A quality appraisal of outpatient antibiotic use in Europe in 2009 based on the 12 ESAC drug-specific quality indicators revealed there is still an important North-South divide. Increased use of macrolides and quinolones, increased proportional use of broad-spectrum penicillins, and an increased ratio of broad-over narrow-spectrum antibiotics seems to cause the largest shifts in quality of outpatient antibiotic use.;Since clinicians rather need disease-specific indicators, we developed a set of 21 (7x3) guideline based disease-specific quality indicators for outpatient antibiotic use in Europe which have face validity and are potentially applicable.