Antibiotic overuse linked to high resistance rates

Overprescribing antibiotics to patients is associated with high rates of antibiotic resistance in southern and eastern Europe, according to a report from the Netherlands. If the situation is not corrected, "we will lose the miracle drugs of the 20th century," the investigators write in this week's issue of The Lancet.

"In view of the emergence of bacterial resistance and the decline in the rate of development of novel antibiotics, effective professional and public strategies to encourage appropriate prescribing of antibiotics should be studied and implemented," Dr. Herman Goossens, from the University of Antwerp in Belgium, and colleagues state.

Goossens' team assessed outpatient antibiotic use in 26 European countries by analyzing data provided between 1997 and 2002. In addition, the researchers correlated such use with antibiotic resistance rates.

The countries varied greatly in antibiotic use, with physicians in France prescribing the most antibodies and physicians in the Netherlands prescribing the least. In general, antibiotic use was higher in southern and eastern Europe and lower in northern Europe.

During the study period, the authors noted an overall shift toward using newer broad-spectrum antibiotics rather than the older narrow-spectrum agents.

Dramatic seasonal variations in antibiotic use were also seen, the investigators note. In particular, countries with high annual use of antibiotics showed heightened peaks of use in the winter.

As noted, a strong correlation was seen between antibiotic use and the development of drug resistance. For example, France, which had the highest outpatient use of penicillins in 2002, also had the highest rate of Streptococcus pneumoniae infections that were resistant to penicillin. Conversely, both of these parameters were lowest in the Netherlands.

"Population-based studies are needed to determine the motivations, expectations, and incentives that lead individuals to use or not use antibiotics," the investigators note.

"The ethics of promoting antibiotics in clinical situations in which they are unnecessary should be given serious consideration," they add.

SOURCE: The Lancet, February 12, 2005.