The relation between sale of antimicrobial drugs and antibiotic resistance in uropathogens in general practice.
BACKGROUND
Overuse of antimicrobial drugs has resulted in an alarming increase in bacterial resistance in most countries. The relevance for general practice is unknown.


OBJECTIVE
To evaluate the impact of the sale of antimicrobial drugs on bacterial resistance as found in uropathogens from general practice.


METHODS
General practice in Belgium and Norway.


METHODS
Observational study.


RESULTS
The sale of antimicrobial drugs indicated for use in the treatment of urinary tract infection was four times higher in Belgium than in Norway (18.5 vs 4.4 DDD/1000 inhabitants/day). The antibiotic resistance reported by microbiological laboratories as valid for general practice was significant higher in Belgium than in Norway (ampicillins (44% vs 27%), co-trimoxazole (28% vs 17%), fluoroquinolones (12% vs 2%) and nitrofurantoin (16% vs 11%, p < 0.0001 for all). However, the antibiotic resistance found in urine samples from dysuric women in general practice was similar (trimethoprim 14% vs 12%, co-trimoxazole 14% vs 11%, nitrofurantoin 7% vs 3%), except in the case of ampicillins (30% vs 19%, p < 0.05).


CONCLUSIONS
The impact of the antimicrobial sale on resistance in uropathogens seems less than expected at the general practice level, even though local microbiological reports mention fairly high antibiotic resistance data. Adapted methods for following-up bacterial resistance evolution in general practice are needed.
Christiaens
Thierry C M
TC
Department of General Practice and Primary Health Care, The University of Ghent, Belgium. thierry.christiaens@rug.ac.be
Digranes
Asbjørn
A
Baerheim
Anders
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D001530:Belgium / Q000453:epidemiology; D004351:Drug Resistance; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D040541:Marketing / Q000706:statistics & numerical data*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017891:Pharmacoepidemiology; D011159:Population Surveillance; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents