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Antibiotic resistance is highest in south and east Europe
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     Resistance to antibiotics is more common in southern and eastern Europe than in northern Europe, because use of antibiotics per person is higher in these regions, according to the first results from a European study.

    The study is part of the European surveillance of antimicrobial consumption project, an international network of surveillance systems for antibiotic use in Europe funded by the European Union. The study compared outpatients' use of antibiotics with rates of antibiotic resistance in 26 European countries from the beginning of 1997 to the end of 2002 ( Lancet 2005;365: 579-87).

    The researchers converted data on outpatient antibiotic use into defined daily doses per 1000 inhabitants per day (the defined daily dose is the assumed average dose per day for a drug used for its main indication in adults, as defined by the World Health Organization).

    The highest rate in 2002 was in France (32.2 defined daily doses per 1000 inhabitants per day), and the lowest was in the Netherlands (10.0). Antibiotic use was generally found to be lower in countries in northern Europe, moderate in eastern Europe, and higher in the south.

    Herman Goossens, project leader and professor of medical microbiology at the University of Antwerp, Belgium, and the University of Leiden, the Netherlands, said that variations in antibiotic use were due mainly to cultural differences, including beliefs about health and disease. He explained: "People in some southern European countries are more anxious about illness than in northern Europe." This may make it more likely that they will consult a doctor and expect drug treatment, he said. Other factors included differences in drug reimbursement systems, availability of antibiotics over the counter, and marketing by drug companies.

    Other results showed that seasonal fluctuations in antibiotic use were highest in southern and eastern European countries, with use being on average 30% higher in the first and fourth quarters of the year than in the second and third quarters.

    In northern European countries antibiotic use was less than 25% higher during the winter, even though there was no difference between the regions in infection rates. The data also showed growing use of the newer, broad spectrum antibiotics.(Susan Mayor)