Basic & Clinical Pharmacology & Toxicology, 2014, 114, 439–440
Doi: 10.1111/bcpt.12241
Letter to the Editor Antibiotic Use and Resistance Dear Editor, I recently read the study of Malo et al. [1], ‘High Antibiotic Consumption: The Characterisation of Heavy Users in Spain’. The study is very good and shows an interesting way to evaluate the intake of medications, especially antibiotics, using the Lorenz curve. The study indicates that children and the elderly are heavy users of antibiotics (January–December 2010). The Lorenz curve is constructed from the number of antibiotics packages purchased per patient per year. The results are surprising. Of the 1,327,827 people evaluated in the study, 433,231 received antibiotics. Therefore, 32.62% of the population of the city, that is, fully one-third of people, received at least one antibiotic treatment during that year. It is important to emphasize that in the case of children classified as ‘heavy users’, the data show that each child consumed on average six packages per year of broad-spectrum antibiotics. These data are very worrying because there is a practice of using antibiotics every 2 months for Spanish children. The data related to antibiotic consumption in this age group reveal that consumption of antibiotics is far higher than what the literature states [2–4]. Inappropriate use and overuse of antibiotics has led to an increase in indicators of antimicrobial resistance [5]. Therefore, therapeutic failures and repeated courses are manifested. The data reported in the study (six uses per year per child) tend to show us repeated courses because of therapeutic failures and not because of new infections. The problem is even more serious because Spain’s use of antibiotics is above the continental average, as well their indicators of antimicrobial resistance [6]. It is essential to have very clear criteria pertaining to the use of antibiotics in children. Adhering to guidelines [7], restricting the sale of antibiotics in Spain [8] and adopting further actions to prevent the use of antibiotics (such as supplementation with vitamin D and antipneumococcal vaccines) is critical [9,10]. Fighting antimicrobial resistance must rely on multiple approaches, for example knowledge of the mechanisms of bacterial resistance, development of new drugs and, most fundamentally, the rational use of antibiotics. Fernando Sa Del Fiol Department of Pharmacology, University of Sorocaba, Sorocaba, Brazil. e-mail: [email protected] References 1 Malo S, Rabanaque MJ, Feja C, Lallana MJ, Aguilar I, Bjerrum L. High antibiotic consumption: a characterisation of heavy users in Spain. Basic Clin Pharmacol Toxicol 2014; DOI: 10.1111/bcpt.12211 [Epub ahead of print]. 2 Vodicka TA, Thompson M, Lucas P, Heneghan C, Blair PS, Buckley DI, et al. Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review. Br J Gen Pract 2013;63:e445–54. 3 Piovani D, Clavenna A, Cartabia M, Bonati M. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol 2012;68:997–1005. 4 Holstiege J, Garbe E. Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr 2013;172:787–95. 5 Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. 6 Adriaenssens N, Coenen S, Versporten A, Muller A, Vankerckhoven V, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): quality appraisal of antibiotic use in Europe. J Antimicrob Chemother 2011;66(Suppl 6):vi71–7. 7 Harris DJ. Initiatives to improve appropriate antibiotic prescribing in primary care. J Antimicrob Chemother 2013;68:2424–7.
© 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society)
440
LETTER TO THE EDITOR
8 Gastelurrutia MA, Larranaga B, Garay A, Echeveste Fde A, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharm Pract 2013;11:185–90. 9 Dagan R, Klugman KP. Impact of conjugate pneumococcal vaccines on antibiotic resistance. Lancet Infect Dis 2008;8:785–95. 10 Bergman P, Lindh AU, Bjorkhem-Bergman L, Lindh JD. Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 2013;8:e65835.
© 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society)
Doi: 10.1111/bcpt.12241
Letter to the Editor Antibiotic Use and Resistance Dear Editor, I recently read the study of Malo et al. [1], ‘High Antibiotic Consumption: The Characterisation of Heavy Users in Spain’. The study is very good and shows an interesting way to evaluate the intake of medications, especially antibiotics, using the Lorenz curve. The study indicates that children and the elderly are heavy users of antibiotics (January–December 2010). The Lorenz curve is constructed from the number of antibiotics packages purchased per patient per year. The results are surprising. Of the 1,327,827 people evaluated in the study, 433,231 received antibiotics. Therefore, 32.62% of the population of the city, that is, fully one-third of people, received at least one antibiotic treatment during that year. It is important to emphasize that in the case of children classified as ‘heavy users’, the data show that each child consumed on average six packages per year of broad-spectrum antibiotics. These data are very worrying because there is a practice of using antibiotics every 2 months for Spanish children. The data related to antibiotic consumption in this age group reveal that consumption of antibiotics is far higher than what the literature states [2–4]. Inappropriate use and overuse of antibiotics has led to an increase in indicators of antimicrobial resistance [5]. Therefore, therapeutic failures and repeated courses are manifested. The data reported in the study (six uses per year per child) tend to show us repeated courses because of therapeutic failures and not because of new infections. The problem is even more serious because Spain’s use of antibiotics is above the continental average, as well their indicators of antimicrobial resistance [6]. It is essential to have very clear criteria pertaining to the use of antibiotics in children. Adhering to guidelines [7], restricting the sale of antibiotics in Spain [8] and adopting further actions to prevent the use of antibiotics (such as supplementation with vitamin D and antipneumococcal vaccines) is critical [9,10]. Fighting antimicrobial resistance must rely on multiple approaches, for example knowledge of the mechanisms of bacterial resistance, development of new drugs and, most fundamentally, the rational use of antibiotics. Fernando Sa Del Fiol Department of Pharmacology, University of Sorocaba, Sorocaba, Brazil. e-mail: [email protected] References 1 Malo S, Rabanaque MJ, Feja C, Lallana MJ, Aguilar I, Bjerrum L. High antibiotic consumption: a characterisation of heavy users in Spain. Basic Clin Pharmacol Toxicol 2014; DOI: 10.1111/bcpt.12211 [Epub ahead of print]. 2 Vodicka TA, Thompson M, Lucas P, Heneghan C, Blair PS, Buckley DI, et al. Reducing antibiotic prescribing for children with respiratory tract infections in primary care: a systematic review. Br J Gen Pract 2013;63:e445–54. 3 Piovani D, Clavenna A, Cartabia M, Bonati M. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol 2012;68:997–1005. 4 Holstiege J, Garbe E. Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr 2013;172:787–95. 5 Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. 6 Adriaenssens N, Coenen S, Versporten A, Muller A, Vankerckhoven V, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): quality appraisal of antibiotic use in Europe. J Antimicrob Chemother 2011;66(Suppl 6):vi71–7. 7 Harris DJ. Initiatives to improve appropriate antibiotic prescribing in primary care. J Antimicrob Chemother 2013;68:2424–7.
© 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society)
440
LETTER TO THE EDITOR
8 Gastelurrutia MA, Larranaga B, Garay A, Echeveste Fde A, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharm Pract 2013;11:185–90. 9 Dagan R, Klugman KP. Impact of conjugate pneumococcal vaccines on antibiotic resistance. Lancet Infect Dis 2008;8:785–95. 10 Bergman P, Lindh AU, Bjorkhem-Bergman L, Lindh JD. Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 2013;8:e65835.
© 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society)
