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The LANCET Volume 365, Number 9459 12 February 2005 Outpatient Antibiotic Use in Europe and Association with Resistance. Herman Goossens, M.D., Ph.D., Matus Ferech, Pharm.D., Robert Vander Stichele, M.D., , Monique Elseviers, Ph.D, and the ESAC Project Group. From the ESAC Management Team, Department of Microbiology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium Address for correspondence: Prof. Dr. H. Goossens Department of Microbiology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium Tel (+) 32 3 821 3789 Fax (+) 32 3 825 4281 E-mail: [email protected] Figure 1 Total Outpatient antibiotic use in 26 European countries in 2002 Others J01B+J01G+J01X 35 Sulfonamides and trimethoprim J01E DDD per 1000 inh. per day 30 25 Quinolones J01M 20 Macrolides, Lincosam., Streptogramins J01F 15 Tetracyclines J01A 10 Cephalosporins J01D 5 Penicillins J01C 0 FR GR LU PT IT BE SK HR PL IS IE ES FI BG CZ SI SE HU NO UK DK DE LV AT EE NL Figure 2 Seasonal variation of total outpatient antibiotic use in 10 European countries 35 BE DK DDD per 1000 inh. pe r day 30 FI 25 GR NL 20 PL 15 PT SE 10 SI UK 5 0 1997 1998 1999 2000 2001 2002 Figure 3 Outpatient use of penicillins (J01C) in 26 European countries in 2002 in descending order of narrow spectrum penicillins 100% β-lactamase resistant penicillins J01F Relative frequency 80% Combinations with βlactamase inhibitors J01R 60% 40% Broad spectrum penicillins J01CA 20% Narrow spectrum penicillins J01CE 0% NO SE DK DE CZ BG FI IS SK SI AT HR HU NL UK IE EE PL GR BE FR ES LV LU PT IT Figure 5 Outpatient use of the third generation Cephalosporins in 2002 Others 2.0 Cefodizime DDD per 1000 inh. per day Ceftazidime 1.5 Cefetamet Cefotaxime 1.0 Ceftriaxone Ceftibuten 0.5 Cefpodoxime Cefixime 0.0 IT FR AT PT ES HU DE HR IE SI GR LV SK PL SE LU NL UK CZ DK EE FI BE NO Figure 6 Outpatient use of Macrolides, Lincosamides and Streptogramins (J01F) in 26 European countries in 2002 Others Rokitamycin Lincomycin DDD per 1000 inh. per day 6 Telithromycin Josamycin Miocamycin Pristinamycin 4 Midecamycin Spiramycin Clindamycin Roxithromycin 2 Erythromycin Azithromycin Clarithromycin 0 GR FR IT LU PT SK BE ES SI AT HU PL CZ IE DE DK UK FI NO HR IS NL EE SE BG LV Figure 7 Outpatient use of Quinolones (J01M) in 26 European countries in 2002 4.0 DDD per 1000 inh. per day Others Lomefloxacin 3.0 Pefloxacin Pipemidic acid Moxifloxacin 2.0 Ofloxacin Levofloxacin 1.0 Norfloxacin Ciprofloxacin 0.0 IT PT BE LU ES GR FR HR SK SI AT HU BG DE PL CZ SE FI NL IS LV IE EE UK NO DK