Antibiotic use in Dutch hospitals 1991–1996

Abstract

The use of antibiotics in Dutch hospitals between 1991 and 1996 was investigated. A total of 54 hospitals responded to the enquiry, representing over 70% of all hospital beds in The Netherlands. The use of antibiotics in Dutch hospitals, expressed as defined daily doses (DDD) per hundred bed days, gradually increased from 37.2 DDD per 100 bed days in 1991 to 42.5 DDD per 100 bed days in 1996. The antibiotic that showed the largest increase in use was co-amoxiclav. Its use increased more than three-fold from 3.93 DDD per 100 bed days in 1991 to 12.5 DDD per 100 bed days in 1996. The increase in use of co-amoxiclav exceeded the increase in total antibiotic consumption. The use of cephalosporins remained fairly constant during the study period, but there were changes in the relative use of the different cephalosporin groups. The use of earlier cephalosporins gradually decreased, whereas the use of the more recently developed cephalosporins increased between 1991 and 1996. Ciprofloxacin and norfloxacin were the most commonly used fluoroquinolones throughout the study period. The use of ofloxacin increased significantly between 1991 and 1996, approaching the levels of use of ciprofloxacin and norfloxacin. There may be complex reasons for the increases, which need further analysis, but they mirror those few data available from elsewhere in the world. Possible explanations include more intensive treatment to expedite patient discharges, sicker patients with more serious infections and more resistant organisms.

Changes in antibiotic use in a general surgery unit over a 5-year period

“…Our data appear to be consistent with data published on antibiotic use trends in other countries over the same time frame. Similar increases were described in studies from Western Europe (13,14) and some studies from Mediterranean and North African countries (6,7).…”

Control of antibiotic use by a unit-dose drug distribution system

“…Similar findings were encountered during an analysis of antibiotic consumption in Dutch hospitals, wherein amoxycillin (6.07 DDD per 100 BDs in 1996) and ampicillin (0.90 DDD per 100 BDs in 1996) were replaced by co-amoxiclav (12.5 DDD per 100 BDs in 1996) for use in surgical prophylaxis [33]. The use of other systemic antiinfectives was negligible.…”

Tetracycline Antibiotics: Mode of Action, Applications, Molecular Biology, and Epidemiology of Bacterial Resistance

“…Therefore it is expected that the use of tetracyclines in humans (Table 7) primarily represents community use. A recent report on the use of antibiotics in Dutch hospitals certainly supports this view (112). The use of tetracyclines for community medicine is declining in many countries, with reduced prescription rates recently recorded for tetracyclines in Spain (23), the United States (172), and the United Kingdom (54).…”

“…Nevertheless, the emergence of bacterial resistance to tetracyclines, the development of alternative agents that are better tolerated and more potent, and the introduction in some countries of legislation to prevent the use of tetracyclines as animal growth promoters are factors influencing the usage of tetracyclines. Although reliable data on production and consumption of antibiotics, including tetracyclines, are notoriously difficult to obtain (49,109,112), such data where available can assist analyses of trends in relation to the clinical and legislative factors mentioned above (109,159). Furthermore, such data provide an indication of the extent to which continuing selection pressure for the emergence of tetracycline resistance is being imposed on human and veterinary pathogens and commensal bacteria (109).…”