Consumption of opioid analgesics in the Nordic countries showed changes over the five year period that cannot be explained by pharmacology, price, reimbursement or prescription regulations. Marketing has most likely significantly influenced the type and amount of opioids consumed.

The connection between regional rates of antimicrobial resistance in Streptococcus pneumoniae and regional antimicrobial use in Finland was investigated. During the 6-year study period of 1997 to 2002, a total of 31,609 S. pneumoniae isolates were tested for penicillin resistance and a total of 23,769 isolates were tested for macrolide resistance in 18 central hospital districts in Finland. The regional macrolide resistance rates were compared with the local use of (i) all macrolides pooled and (ii) azithromycin. The penicillin resistance levels were compared with the consumption data for (i) penicillins, (ii) cephalosporins, (iii) all beta-lactams pooled, and (iv) all macrolides pooled. A statistically significant association between macrolide resistance and total use of macrolides and the use of azithromycin was found. Moreover, total use of beta-lactams and total use of cephalosporins were significantly connected to low-level penicillin resistance. A statistically significant association between penicillin-nonsusceptible isolates and penicillin or total macrolide consumption was not found.In conclusion, total macrolide use and azithromycin use are associated with increased macrolide resistance, and beta-lactam use and cephalosporin use are connected to increased low-level penicillin resistance in S. pneumoniae. Unnecessary prescribing of macrolides and cephalosporins should be avoided.Antimicrobial resistance in Streptococcus pneumoniae poses a major challenge for the management of pneumococcal infections including pneumonia, otitis media, sinusitis, meningitis, and sepsis. Penicillins and macrolides are often used in the treatment of respiratory tract infections. Therefore, it is not surprising that resistance to these drugs in S. pneumoniae has increased in many areas (8).A number of studies show that increased outpatient antimicrobial consumption is connected to increased antimicrobial resistance in S. pneumoniae (11,19,21). On the other hand, a decrease in the use of antimicrobials may, or may not, result in a decline in resistance levels in streptococci (1, 2, 24). However, many factors in this relationship need to be surveyed. It is not clear, for instance, how much and how quickly the consumption of a specific antimicrobial needs to increase to produce a given resistance level in a given community or area, where other factors such as housing, transport, and hygiene circumstances may also contribute to the spread of resistant clones.In this study, we investigated, in a nationwide study setting, whether antimicrobial resistance in S. pneumoniae is connected to previous antimicrobial use in Finland. We utilized data regarding a considerable number of pneumococcal isolates collected during 6 years by a comprehensive clinical microbiology laboratory network covering the entire country and data for annual regional drug consumption. With these data, we were able to conduct a regional survey on antimicrobial consumption and antibacterial resistance (2, 13). MATERIALS AND METHODSMacrolide and penicillin resista...

Caution is required when interpreting the data on opioid consumption between countries because of differences in the collection and reporting of data. Better recording of opioid consumption is needed for meaningful analysis of opioid consumption and its possible effect on pain management in different countries. Data on opioids consumed for cancer-related pain in comparison with chronic non-malignant pain are needed. A uniform method of collection of data on analgesic consumption should be established for all European countries.

During a 9-year study period from 1997 through 2005, the association between antimicrobial resistance rates in Escherichia coli and outpatient antimicrobial consumption was investigated in 20 hospital districts in Finland. A total of 754,293 E. coli isolates, mainly from urine samples, were tested for antimicrobial resistance in 26 clinical microbiology laboratories. The following antimicrobials were studied: ampicillin, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, trimethoprim, trimethoprim-sulfamethoxazole, pivmecillinam, and nitrofurantoin. We applied a protocol used in earlier studies in which the level of antimicrobial consumption over 1 year was compared with the level of resistance in the next year. Statistically significant associations were found for nitrofurantoin use versus nitrofurantoin resistance (P < 0.0001), cephalosporin use versus nitrofurantoin resistance (P ‫؍‬ 0.0293), amoxicillin use versus fluoroquinolone resistance (P ‫؍‬ 0.0031), and fluoroquinolone use versus ampicillin resistance (P ‫؍‬ 0.0046). Interestingly, we found only a few associations between resistance and antimicrobial consumption. The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance.Urinary tract infection (UTI) is one of the most common indications for antimicrobial treatment. The development of antimicrobial resistance in Escherichia coli has an influence on the successful treatment of UTIs. The rates of resistance to aminopenicillins and fluoroquinolones among E. coli isolates are on the increase, and many isolates already show resistance to two or more classes of antimicrobials (6, 7).According to current Finnish care recommendations, the first-line antimicrobial agents for the treatment of uncomplicated cystitis are trimethoprim, pivmecillinam, nitrofurantoin, or a fluoroquinolone (28). Cephalexin (cefalexin) or cefadroxil, trimethoprim-sulfamethoxazole, and amoxicillin (amoxicilline) are recommended for use as second-line drugs (28). In Finland, 32% of UTIs are treated with trimethoprim, 18% with pivmecillinam, 16% with nitrofurantoin, and 16% with fluoroquinolones (21).Studies describing the relationship between antimicrobial consumption and resistance in E. coli show that there is no clear evidence of how these two factors are linked to each other (13,25). Some reports suggest a positive association between antimicrobial consumption and bacterial resistance (19,26), while others claim that such associations are not evident (1, 4).The aim of the study described here was to investigate the association between the regional rates of antimicrobial resistance among E. coli isolates and antimicrobial consumption in 20 hospital districts in Finland. MATERIALS AND METHODSBacterial isolates and resistance data. A total of 754,293 E. coli isolates were tested for antimicrobial resistance in Finland during a 9-year study period from 1997 through 2005. The number of isolates tested in each central hospital district per yea...

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