title: European Surveillance of Antimicrobial Consumption (ESAC): outpatient penicillin use in Europe (1997-2009).
abstract: BACKGROUND
  Data on 13 years (1997-2009) of outpatient penicillin use were collected from 33 European countries within the European Surveillance of Antimicrobial Consumption (ESAC) project and analysed in detail.
  
  
  METHODS
  For the period 1997-2009, data on outpatient use of systemic penicillins aggregated at the level of the active substance were collected using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) method (WHO, version 2011) and expressed in DDD per 1000 inhabitants per day (DID). For detailed analysis of trends over time, seasonal variation and composition of outpatient penicillin use in 33 European countries, we distinguished between narrow-spectrum penicillins (NSP), broad-spectrum penicillins (BSP), penicillinase-resistant penicillins (PRP) and combinations with β-lactamase inhibitors (COP).
  
  
  RESULTS
  Total outpatient penicillin (ATC group J01C) use in 2009 varied by a factor of 3.8 between the countries with the highest (16.08 DID in France) and lowest (4.23 DID in the Russian Federation) use. COP represented 45.8%, BSP 40.7%, NSP 10.8% and PRP 2.6% of total European outpatient penicillin use. Total outpatient penicillin use significantly increased over time by 1.53 (SD 0.71) DID between 1997 and 2009. COP (mainly co-amoxiclav) increased by 2.17 (SD 0.40) DID, which was the result of its absolute increase as well as the observed shift from NSP and BSP towards COP. This increase exceeded 10% in 20 countries, where it coincided with a similar decrease in either BSP (15 countries) or NSP (5 countries).
  
  
  CONCLUSIONS
  Penicillins represented the most widely used antibiotic subgroup in all 33 participating countries, albeit with considerable variation in their use patterns. For Europe, a continuous increase in overall penicillin use and of COP use was observed during the period 1997-2009.
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium. ann.versporten@ua.ac.be
authors.forename: Ann
authors.initials: A
authors.lastname: Versporten
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Niels
authors.initials: N
authors.lastname: Adriaenssens
authors.forename: Arno
authors.initials: A
authors.lastname: Muller
authors.forename: Girma
authors.initials: G
authors.lastname: Minalu
authors.forename: Christel
authors.initials: C
authors.lastname: Faes
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vankerckhoven
authors.forename: Marc
authors.initials: M
authors.lastname: Aerts
authors.forename: Niel
authors.initials: N
authors.lastname: Hens
authors.forename: Geert
authors.initials: G
authors.lastname: Molenberghs
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
mesh_terms: D000553:Ambulatory Care; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005060:Europe; D006801:Humans; D010045:Outpatients / Q000706:statistics & numerical data*; D010406:Penicillins / Q000627:therapeutic use*; D017891:Pharmacoepidemiology / Q000379:methods; D012621:Seasons; D013223:Statistics as Topic / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D019980:Amoxicillin-Potassium Clavulanate Combination