title: European Surveillance of Antimicrobial Consumption (ESAC): outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe (1997-2009).
abstract: BACKGROUND
  Data on more than a decade of outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe were collected from 33 countries within the European Surveillance of Antimicrobial Consumption (ESAC) project, funded by the European Centre for Disease Prevention and Control (ECDC), using the WHO Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology.
  
  
  METHODS
  For the period 1997-2009, data on outpatient use of systemic MLS aggregated at the level of the active substance were collected and expressed in DDD (WHO, version 2011) per 1000 inhabitants per day (DID). Using a classification based on mean plasma elimination half-life, macrolide use was analysed for trends over time, seasonal variation and composition.
  
  
  RESULTS
  Total outpatient MLS use in 2009 varied by a factor of 18 between the countries with highest (11.5 DID in Greece) and lowest (0.6 DID in Sweden) use. MLS use showed high seasonal variation. Short-, intermediate- and long-acting macrolides were the most commonly used agents in 2, 25 and 5 countries, respectively (mainly erythromycin, clarithromycin and azithromycin, respectively). In Sweden, mainly lincosamides (clindamycin) were used. Lincosamide use was observed in all countries, while substantial use of a streptogramin was only seen in France (pristinamycin). For Europe, a significant increase in outpatient MLS use was found, as well as a significant seasonal variation, which increased over time from 1997 to 2009. Relative use of long-acting macrolides and lincosamides significantly increased over time with respect to intermediate-acting macrolides, and relative use of the latter increased with respect to short-acting macrolides.
  
  
  CONCLUSIONS
  The observed differences between European countries in the levels of MLS use and the extreme seasonal variations in their use suggest that this subgroup of antibiotics is still prescribed inappropriately in many countries.
authors.affiliation: Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium. niels.adriaenssens@ua.ac.be
authors.forename: Niels
authors.initials: N
authors.lastname: Adriaenssens
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Ann
authors.initials: A
authors.lastname: Versporten
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; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005060:Europe; D006207:Half-Life; D006801:Humans; D055231:Lincosamides / Q000737:chemistry / Q000627:therapeutic use*; D018942:Macrolides / Q000737:chemistry / Q000627:therapeutic use*; D010045:Outpatients / Q000706:statistics & numerical data*; D017891:Pharmacoepidemiology / Q000379:methods; D012621:Seasons; D013223:Statistics as Topic / Q000379:methods; D025361:Streptogramins / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D055231:Lincosamides; D018942:Macrolides; D025361:Streptogramins