European Surveillance of Antimicrobial Consumption (ESAC): outpatient systemic antimycotic and antifungal use in Europe.
OBJECTIVE
To assess the total outpatient systemic antimycotic and antifungal use in Europe, and to identify the antimycotic and antifungal substances most commonly used.


METHODS
Within ESAC (www.esac.ua.ac.be), using the anatomical therapeutic chemical (ATC) and defined daily dose (DDD) classification, data on outpatient use of all 14 antimycotics (12) and antifungals (2) for systemic use (ATC J02 and D01B, respectively), aggregated at the level of the active substance, were collected for 2007. Use was expressed in DDD (WHO ATC/DDD, version 2008) per 1000 inhabitants per day (DID). Only countries for which data on both J02 and D01B use were available were included in the analysis.


RESULTS
In 20 European countries (data for Cyprus and Estonia include hospital use), total outpatient systemic antimycotic and antifungal use varied by a factor of 6.7 between the country with the highest (3.03 DID in Belgium) and the country with the lowest (0.45 in Croatia) use. Terbinafine, ketoconazole, itraconazole and fluconazole represented >94% of the total outpatient antimycotic and antifungal use in all countries. Terbinafine use represented >50% of the total systemic antimycotic and antifungal use in 16 out of 20 countries (not in Croatia, Italy, Luxembourg and Bulgaria).


CONCLUSIONS
We present for the first time a standardized and validated data set of outpatient systemic antimycotic and antifungal use in Europe. Our study demonstrates a variation of antimycotic and antifungal use in Europe, as striking as that of antibiotic use. The ESAC data facilitate the auditing of antimycotic and antifungal prescribing, and the evaluation of the implementation of guidelines and public health policies to promote their judicious use.
Adriaenssens
Niels
N
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium. Niels.Adriaenssens@ua.ac.be
Coenen
Samuel
S
Muller
Arno
A
Vankerckhoven
Vanessa
V
Goossens
Herman
H
D000553:Ambulatory Care; D000935:Antifungal Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005060:Europe; D006801:Humans
D000935:Antifungal Agents