In Europe, antimicrobial resistance has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS). We examined the relationship between penicillin nonsusceptibility of invasive isolates of Streptococcus pneumoniae (an indicator organism) and antibiotic sales. Information was collected on 1998-99 resistance data for invasive isolates of S. pneumoniae to penicillin, based on surveillance data from EARSS and on outpatient sales during 1997 for beta-lactam antibiotics and macrolides. Our results show that in Europe antimicrobial resistance is correlated with use of beta-lactam antibiotics and macrolides.

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In the elderly, influenza vaccination may halve the incidence of serological and clinical influenza (in periods of antigenic drift).

Objective-To assess the frequency and type of side effects after influenza vaccination in elderly people.Design-Randomised double blind placebo controlled study.Setting-15 general practices in the southern Netherlands.Subjects-1806 patients aged 60 or older, of whom 904 received influenza vaccine and 902 placebo.Main outcome measures-Adverse reactions reported on postal questionnaire completed four weeks after vaccination.Results-210 (23%) patients given vaccine reported one or more adverse reactions compared with 127 (14%) given placebo. The frequency oflocal adverse reactions were 17-5% in the vaccine group and 7-3% in the placebo group (p < 0.001). There was no difference in systemic adverse reactions (11% v 9.4%; p=034). In general, men reported fewer side effects than women.Conclusion-Only local side effects were more common in vaccinated patients and all side effects were mild.

Based on data from the Dutch Central Bureau of Statistics, the impact of influenza on mortality in The Netherlands was estimated for a 22.5-year period (1967-1989) in four age groups and three entities of disease, using Poisson regression techniques. Our analysis suggests that, on average, more than 2000 people died from influenza in The Netherlands each year, but in only a fraction of these deaths was influenza recognized as the cause of death. For each case of death registered as caused by influenza (registered influenza mortality), 2.6 additional cases of death registered as due to causes other than influenza, nevertheless, were influenza-related (non-registered influenza mortality). Therefore, the overall impact of influenza on mortality is estimated to be greater than registered influenza mortality by a factor of 3.6. Those under 60 years of age accounted for 5% of all non-registered influenza deaths, whereas people aged 60-69, 70-79 years and > 80 years accounted for 12%, 29% and 54% of such deaths, respectively. When extrapolating the figures for the Dutch population of 1989, we could attribute, on average per season-year, 82 deaths per 100,000 people > 60 years, 143 in people > 70 years, and 280 in people > 80 years. Of all non-registered influenza cases of death, 47% were estimated to occur in people with heart disease as a primarily reported cause of death, 23% in those with lung disease, and 30% in those with other diseases. This study stresses the serious effects of influenza, mainly in the elderly (95% of non-registered influenza mortality).(ABSTRACT TRUNCATED AT 250 WORDS)