The study is important, as the data will prove useful for assessing public health strategies that aim to reduce inappropriate antibiotic use and resistance levels. Differences in antibiotic use between countries might explain variations in incidence of community infections, culture and education, differences in drug relations and in the structure of the national pharmaceutical market.
Antibiotic use was compared with antibiotic resistance rates in 26 European countries from the beginning of 1997 to the end of 2002. To control for the different population sizes the investigators expressed data in defined daily dose per 1000 inhabitants daily (DID).
The study found that prescription rates in Europe varied greatly with France having the highest rate (32.2 DID) and Netherlands having the lowest (10.0 DID). Across Europe antibiotic use was lower in northern, moderate in eastern and higher in southern regions.
Seasonal fluctuations were high in southern and eastern European countries, whereas in northern European countries the increase in antibiotic use during the winter was less than 25 per cent.
In most countries the researchers found a growing use of the newer antibiotics (active against a broad spectrum of micro-organisms) and a decline in use of the older antibiotics (active against a narrow spectrum of micro-organisms).
However, the study, lead by Herman Goossens at the University of Antwerp in Belgium, was criticised for its lack of scientific standards. However, while the methods used by Goossens and colleagues to correlate antimicrobial use with resistance have been crude, they had also been effective.
Goossens concluded: "Population-based studies are needed to determine the motivation and incentives that lead individuals to use or not to use antibiotics. The ethics of promoting antibiotics in clinical situations in which they are unnecessary should be given serious consideration."
"In view of the emergence of bacterial resistance and the decline in the rate of development of novel antibiotics, effective professional and public strategies to encourage appropriate prescribing of antibiotics should be studied and implemented. If not, we will lose the miracle drugs of the 20th century."
However Professor John Turnidge of the Women's and Children's Hospital in North Adelaide, Australia, responded by saying: "If we develop more sophisticated systems to measure antimicrobial use that incorporate the many influences, such as the proportion of individuals exposed, the proportion of children in the population, population densities, the effects of different drug classes, and the differences between bacterial species, it will help us to design and measure the success of intervention strategies."
According to a 2004 report from the European Antimicrobial Resistance Surveillance System (EARSS), an infectious disease network of 28 countries, there is an increasing incidence of Escherichia coli strains resistant to third-generation cephalosporins, a consistent rise in fluoroquinolone resistance, and resistance rates of more than 50 per cent to ampicillin.
EARSS monitors resistance in several other major pathogens, including Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis and E. faecium, but it singles out E. coli resistance as showing the most worrying trends. The report stated that multiresistant bacteria posed a "potentially serious impediment" to transplant surgery, cancer therapy and treatment of infections.