Outpatient antibiotic use in France between 2000 and 2010: after the nationwide campaign, it is time to focus on the elderly - PubMed (original) (raw)

Outpatient antibiotic use in France between 2000 and 2010: after the nationwide campaign, it is time to focus on the elderly

Adeline Bernier et al. Antimicrob Agents Chemother. 2014.

Abstract

Antibiotic overconsumption is the main force driving the emergence of multidrug-resistant bacterial strains. To promote better antibiotic use in France, a nationwide campaign has been run every year from October to March since 2002. In 2007, it was shown that winter outpatient antibiotic consumption had decreased by 26.5% compared to the 2000-2002 baseline period. Here, we quantified outpatient antibiotic use between 2000 and 2010 as a follow-up analysis of the nationwide campaign. Reimbursed outpatient antibiotic prescriptions were extracted from computerized French National Health Insurance databases. Entire series and age group and antibiotic class analyses were computed. Time series analyses used autoregressive moving-average models with exogenous variables and intervention functions. Two periods were considered: October to March "campaign" periods and April to September "warm" periods. Compared to the precampaign (2000-2002) baseline period, the numbers of weekly antibiotic prescriptions per 1,000 inhabitants during campaign periods decreased until winter 2006 to 2007 (-30% [95% confidence interval {CI}, -36.3 to -23.8%]; 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.

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Figures

FIG 1

FIG 1

Overall weekly antibiotic consumption per 1,000 inhabitants (plain) and flu-like syndrome incidence (dotted) between 2000 and 2010, periods and intervention functions used for the construction of the ARMAX model. Dummy variables are c1 to c8 (campaign period) and w1 to w7 (warm period).

FIG 2

FIG 2

Overall weekly antibiotic consumption per 1,000 inhabitants between 2000 and 2010, ARMAX model predictions, and estimated differences in percentages for campaign and warm periods. Black lines are expected antibiotic consumption levels during campaign and warm periods under the assumption of no change since the baseline period (2000 to 2002). Red lines are antibiotic consumption levels during campaign and warm periods predicted by the model. The indicated percentages are relative changes compared to the baseline period. ∗∗∗, P < 0.001 compared to baseline values (t test).

FIG 3

FIG 3

Estimated percent differences compared to the baseline period (2000 to 2002) during campaign (top) and warm (bottom) periods for the entire series and by age group and therapeutic class. ∗, P < 0.05 compared to baseline values (t test). Asterisks were lined up when the space between dots was too small.

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