Outpatient Antibiotic Use in France between 2000 and 2010: after the Nationwide Campaign, It Is Time To Focus on the Elderly

Abstract

.8%]; P < 0.001) and then stabilized except for individuals >60 years of age, for whom prescriptions reached the precampaign level. During the warm periods from April to September, no significant differences were estimated compared to the baseline level for the entire series, but seniors had an increasing trend that became significant as of 2005, reaching ؉21% (95% CI, ؉12.9 to ؉29.6%) in 2009 (P < 0.0001). These results highlight the need for a better understanding of antibiotic use by the elderly, requiring research with targeted and tailored public health actions for this population. Over the last 4 decades, the emergence and dissemination of multidrug-resistant bacterial strains have become major global health issues (1). Because of antibiotic resistance, management of bacterial infections is becoming more complex, and numbers of treatment failures are increasing. In the European Union, an estimated 25,000 deaths are caused by drug-resistant bacteria annually (2). In the community, ␤-lactam-resistant Streptococcus pneumoniae is one of the best-known bacteria that has disseminated during the past 20 years. Antibiotic overuse is the main force driving the spread of multidrug-resistant bacteria (3, 4). In developed countries, antibiotics are prescribed mostly in outpatient settings for upper respiratory tract infections. However, because most of these infections are viral, antibiotics are usually unnecessary (5, 6, 7).In the early 2000s, France had the highest rate of antibioticresistant S. pneumoniae in Europe and was identified as one of the highest antimicrobial users worldwide (3). In this context, a nationwide public health campaign was launched ("Antibiotics Are Not Automatic!" and "Antibiotics, Used Unnecessarily, Lose Their Potency!") and has been repeated every winter from October to March (period of highest antibiotic consumption) since 2002, with the main goal of decreasing prescriptions in the community, particularly for children. In addition, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2003 to prevent invasive S. pneumoniae disease in children Ͻ2 years old at risk because of medical or living conditions. It was further expanded to every child Ͻ2 years old.Between 2002 and 2007, winter outpatient antibiotic consumption decreased by 26.5% compared to the baseline 2000-2002 period (8). Because no detailed and prolonged longitudinal antibiotic consumption evaluation has been performed since then, it is not known whether the decreasing trend of outpatient antibiotic consumption has been sustained. Moreover, such information, according to age group and antibiotic class, is crucial to refining the communication strategies directed toward physicians. Therefore, by using time series analyses, we quantified the evolutions of outpatient antibiotic use between 2002 and 2010 for the entire series and by age group and therapeutic class. MATERIALS AND METHODSData sources. French National Health Insurance (NHI) covers all medical care provided by outpatient and private-practice physicians ...

Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly

“…The significant association of BSI with STC 131 and A/B1 isolates and recent antibiotic treatment suggested that prior exposure of the gut to antibiotics might have led to long-lasting, strong colonization by these isolates, this process being favored by the high frequency of antibiotic resistance genes in their genomes. Recent reports concerning antibiotic consumption (Bernier et al, 2014 ; http://www.cclin-arlin.fr , 2014) 1 have described an increase in the use of antibiotics by the elderly over the study period. As data from our region were included in these studies, these trends toward an increase may apply to our region.…”

How to improve antibiotic awareness campaigns: findings of a WHO global survey

“…Examples from Belgium and France have shown that national campaigns may reduce overall antibiotic consumption, but have difficulty sustaining these successes over time 53 54. Experiences from other public health campaigns show that repeated exposure of the targeted public over long periods of time is often necessary to exert a sustained effect 47 55.…”

Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

“…As for other high-income countries that introduced PCV13 [6, 7, 23–25], in France, serotype 3 remained among the most frequent in older adults 4 years after PCV13 introduction, probably because of the absence of herd protection for this penicillin-susceptible serotype, which is rare in young children more frequently exposed to antibiotic consumption [26]. A recent study of the impact of PCV13 on PM cases in US children 3 years following vaccine introduction revealed that PM case numbers remain unchanged in the study sample and serotype 19A continued to be the most common serotype [27].…”