Outpatient Antibiotic Use and Prevalence of Antibiotic-Resistant Pneumococci in France and Germany: A Sociocultural Perspective

Abstract

The prevalence of penicillin-nonsusceptible pneumococci is sharply divided between France (43%) and Germany (7%). These differences may be explained on different levels: antibiotic- prescribing practices for respiratory tract infections; patient-demand factors and health-belief differences; social determinants, including differing child-care practices; and differences in regulatory practices. Understanding these determinants is crucial for the success of possible interventions. Finally, we emphasize the overarching importance of a sociocultural approach to preventing antibiotic resistance in the community.

A Brave New World: The Lung Microbiota in an Era of Change

“…Extrapolating from the prevalence data in 2010 across the United States suggests that the average child may be receiving nearly 3 courses of antibiotics by the time they are 2, 11 courses by the time they are 10, and 17 courses by the time they are 20 years old. Such data are consistent with more limited studies in other developed countries (63)(64)(65).…”

Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from Switzerland

“…Webb and Lloyd (1994) suggested that older people are more likely to be prescribed a medication, although this result is not confirmed by Cockburn and Pit's study. Harbarth et al (2002) suggested that large differences in antibiotic consumption between France and Germany are at least partially related to differences in the concentration of child care facilities and the use of breast feeding between the two countries. Finally, Unsworth and Walley (2001) showed that antibiotic prescribing is related to practice characteristics in the British NHS.…”

The determinants of the antibiotic resistance process

“…6,78 Some important errors include delayed antibiotic administration, excessive duration and the use of inappropriate agents. 73 Although the chain of causality is not clear, selection of resistant bacteria has been promoted by multiple courses of antibiotics, fi rst-line treatment with broad spectrum antibiotics, long duration antibiotic treatment, and antibiotic treatment of viral infections of the respiratory tract. When clinicians are not sure whether an infection is bacterial, they tend to prescribe antibiotics.…”

“…Several broad infl uences on antibiotic decision-making can be identifi ed, which help to explain the different resistance rates: 6,73 • The fi rst is the behavior of the antibiotic prescriber, that is, the physician, physician extender, or nurse practitioner. Physicians differ in their choice, use and prescribed dose of antibiotics.…”

“…There are some actions that are widely agreed to be essential areas of general consensus for recommended action. 7,20,73,85,90,94,[110][111][112][113][114][115][116][117][118][119] Local governments should establish policies for the elaboration of national and regional guidelines for infection control based on surveillance data on resistance and reinforce the general health laws in the dispensing of antibiotics at all levels as well as eliminate fi nancial incentives that promote misuse of antibiotics.…”