title: European Surveillance of Antimicrobial Consumption (ESAC): outpatient parenteral antibiotic treatment in Europe.
abstract: OBJECTIVE
  To assess the proportion of parenteral treatment of the total outpatient antibiotic use in Europe, and to identify the antibiotic groups and individual antibiotics most commonly administered in this way.
  
  
  METHODS
  Within the European Surveillance of Antimicrobial Consumption (ESAC; www.esac.ua.ac.be), using the anatomic therapeutic chemical (ATC) and defined daily dose (DDD) classification, data on outpatient use of antibacterials for systemic use (ATC J01), aggregated at the level of the active substance and expressed in DDD per 1000 inhabitants per day (DID; WHO version 2007), were extracted for 2006 by route of administration and by country. Parenteral use was expressed as a percentage of the total outpatient use in DID.
  
  
  RESULTS
  In 20 European countries, the total outpatient antibiotic use ranged from 27.91 DID in France to 9.58 DID in Russia. The proportion of outpatient parenteral antibiotic treatment ranged from 6.75% in Russia to 0.001% in Iceland. The three most commonly used antibiotic groups for parenteral treatment in Europe were the cephalosporins (J01D; 44.58%), the aminoglycosides (J01G; 25.27%) and the penicillins (J01C; 17.78%). Four antibiotics [gentamicin (J01GB03) 18.53%; ceftriaxone (J01DD04) 17.85%; cefazolin (J01DB04) 13.16%; and lincomycin (J01FF02) 5.47%] represented more than half of the use.
  
  
  CONCLUSIONS
  In all 20 European countries studied together, 2.04% of outpatient antibiotics were used for parenteral treatment. However, as for the total outpatient antibiotic use and the use of different antibiotic groups and antibiotics, there is a striking variation in the proportions of parenteral antibiotic use in Europe. More in-depth data on outpatient antibiotic use are needed to explain this variation.
authors.affiliation: Department of General Practice, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium. samuel.coenen@ua.ac.be
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Arno
authors.initials: A
authors.lastname: Muller
authors.forename: Niels
authors.initials: N
authors.lastname: Adriaenssens
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vankerckhoven
authors.forename: Erik
authors.initials: E
authors.lastname: Hendrickx
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005060:Europe; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D010045:Outpatients
chemical_list: D000900:Anti-Bacterial Agents