Immunology

A new study, published in The Lancet Infectious Diseases journal, provides the first ever reliable data on antibiotic use in non-European Union (EU) southern and eastern European countries and newly independent states.

The research, which was led by Dr Herman Goossens, of the Vaccine and Infectious Disease Institute (VAXINFECTIO) at the University of Antwerp, Belgium, is a critical first step in identifying targets for improvements in the way antibiotics are used in these countries. The authors hope that the findings will aid the development of national action plans to enhance judicious antibiotic use, and curb the rising threat of antibiotic resistance.

Dr Goossens and colleagues, who conducted the study on behalf of the WHO/Europe-ESAC Project Group, used surveillance methods already used to successfully monitor antibiotic use in EU countries to estimate average antibiotic use per person in thirteen non-EU countries and areas of the WHO European region, as well as collecting data on the types of antibiotics used, and how they were administered.

In many of the countries studied, health information systems were poor, and lack of universal health coverage made collecting reliable data on antibiotic use challenging. However, the researchers used information from a variety of sources, including wholesale sales data, to produce a robust estimate of overall antibiotic use in the countries studied, and the inclusion of sales data meant that this estimate also included over-the-counter non-prescription antibiotic use.

Of the countries studied, Turkey had the highest antibiotic use, with average antibiotic use per person nearly three times higher than the country with the lowest levels of antibiotic use included in the study, Armenia.

The finding that Turkey has outstandingly high levels of antibiotic use â€" the highest of any country in the WHO European region â€" has already resulted in the Turkish government formulating a national action plan on rational drug use, and the study authors hope that the new results will prompt similar action in the other countries studied.

In some countries, unexpectedly high usage of powerful broad-spectrum antibiotics, such as quinolones or combinations of amoxicillin and β-lactamase inhibitors, suggests that these drugs are being inappropriately used as first line treatments for infections, despite current guidelines recommending these drugs for second-line treatment only.

According to the authors, “High rates of self-medication with antibiotics might go along with the underuse of health services or might lead to diagnostic and health-care system seeking delays. Therefore, restriction of over-the-counter use of antibiotics is urgently needed, and could be partly achieved by implementing national regulatory instruments, public awareness campaigns, or enhancing efforts in educating health-care providers towards appropriate prescribing.”