JAC Advance Access originally published online on May 8, 2007
Journal of Antimicrobial Chemotherapy 2007 60(1):179-180; doi:10.1093/jac/dkm134
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Correspondence |
Comment on: Can mass media campaigns change antimicrobial prescribing? A regional evaluation study
1 Department of General Practice, University of Antwerp, Antwerp, Belgium 2 Scientific Research Foundation—Flanders, Brussels, Belgium 3 Belgian Antibiotic Policy Coordinating Committee, Federal Public Service for Heath, Security of the Food Chain and Environment, Brussels, Belgium 4 Laboratory of Microbiology, University of Antwerp, Antwerp, Belgium 5 Laboratory of Microbiology, Leiden University Medical Center, Leiden, The Netherlands
* Correspondence address. Department of General Practice, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. Tel: +32-3-820-2525; Fax: +32-3-820-2526; E-mail: samuel.coenen{at}ua.ac.be
Keywords: antibiotic use , public campaigns , prescribing behaviour , ambulatory care , Europe
Lambert et al.1 reported on the effect of two sequential mass media campaigns, providing information on the appropriate use of antimicrobials. We acknowledge that evaluating such campaigns can be problematic and that uncontrolled observations can be misleading. Nonetheless, as the authors state too, ensuring equivalence of the study groups in a controlled study can also be cumbersome. Given the evidence linking antibiotic use with resistance both at ecological2 and individual levels,3 and of the overuse of antibacterials in many countries,2,4 we compared the results of their controlled study of a regional intervention with those of national public campaigns in two high consuming countries, France (www.antibiotiquespasautomatiques.com) and Belgium (www.red-antibiotica.org and www.antibiotics-info.be).5,6
Before-and-after assessments showed a reduction in new antibacterial prescriptions per inhabitant over a 6 month period of 13% (19% in children aged under 15 years) 3 years after the start of public campaigns in France.5 In Belgium, the antibacterial use expressed in defined daily doses per 1000 inhabitants per day (DID) decreased by 6.5% (P < 0.05) and 3.4% (non-significant) after the first and second campaigns, respectively, yielding a saving/cost ratio of 5.54.5,6 The effect on the prescribing behaviour of ambulatory care physicians in Belgium might however be underestimated using DID as an outcome measure, because during these years, the content of an average pack increased (both by increase of strength and of pack size). After all, expressing antibacterial use in packages—a proxy for prescriptions—per 1000 inhabitants per day shows an average decrease of 6.9% (SD = 2.0) for 5 years since the start of the Belgian public campaigns in the 2000–01 winter season (Figure 1).
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As their effect in the Northeast of England, France and Belgium is similar, we believe one can be quite confident that public campaigns are (cost)effective interventions to improve antibacterial prescribing on both regional and national levels.
None to declare.
References
1
Lambert MF, Masters GA, Brent SL. Can mass media campaigns change antimicrobial prescribing? A regional evaluation study. J Antimicrob Chemother (2007) 59:537–43.
2 Goossens H, Ferech M, Stichele RV, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet (2005) 365:579–87.[Web of Science][Medline]
3 Malhotra-Kumar S, Lammens C, Coenen S, et al. Impact of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci among healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet (2007) 369:482–90.[CrossRef][Web of Science][Medline]
4
Ferech M, Coenen S, Malhotra-Kumar S, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe. J Antimicrob Chemother (2006) 58:401–7.
5 Goossens H, Guillemot D, Ferech M, et al. National campaigns to improve antibiotic use. Eur J Clin Pharmacol (2006) 62:373–9.[CrossRef][Web of Science][Medline]
6
Bauraind I, Lopez-Lozano JM, Beyaert A, et al. Association between antibiotic sales and public campaigns for their appropriate use. In: JAMA (2004) 292:2468–70.
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