title: Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe.
abstract: BACKGROUND
  There are no reliable data on antibiotic use in non-European Union (EU) southern and eastern European countries and newly independent states. We aimed to collect valid, representative, comparable data on systemic antimicrobial use in these non-EU countries of the WHO European region.
  
  
  METHODS
  Validated 2011 total national wholesale antibiotic-use data of six southern and eastern European countries and regions and seven newly independent states were analysed in accordance with the WHO anatomical therapeutic chemical (ATC)/defined daily doses (DDD) method and expressed in DDD/1000 inhabitants per day (DID).
  
  
  RESULTS
  Total (outpatients and hospital care) antibiotic use ranged from 15·3 DID for Armenia to 42·3 DID for Turkey. Co-amoxiclav was mainly used in Georgia (42·9% of total antibiotic use) and Turkey (30·7%). Newly independent states used substantial quantities of ampicillin and amoxicillin (up to 55·9% of total antibiotic use in Azerbaijan). Montenegro and Serbia were the highest consumers of macrolides (15·8% and 19·5% of total antibiotic use, respectively), mainly azithromycin. Parenteral antibiotic treatment is common practice: 46·4% of total antibiotic use in Azerbaijan (mainly ampicillin; 5·3 DID) and 31·1% of total antibiotic use in Tajikistan (mainly ceftriaxone; 4·7 DID).
  
  
  CONCLUSIONS
  This study provides publicly available total antibiotic-use data for 13 non-EU countries and areas of the WHO European region. These data will raise awareness of inappropriate antibiotic use and stimulate policy makers to develop action plans. The established surveillance system provides a method to develop quality indicators of antibiotic use and to assess the effect of policy and regulatory actions.
  
  
  BACKGROUND
  Netherlands Ministry of Health, Welfare, and Sport, and EU.
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Versporten
authors.affiliation: Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Ganna
authors.initials: G
authors.lastname: Bolokhovets
authors.affiliation: Scientific Centre of Drug and Medical Technology Expertise of the Ministry of Health, Yerevan, Armenia.
authors.forename: Lilit
authors.initials: L
authors.lastname: Ghazaryan
authors.affiliation: Ministry of Health of Azerbaijan Republic, Analytical Expertise Centre for Medicines, Baku, Azerbaijan.
authors.forename: Vafa
authors.initials: V
authors.lastname: Abilova
authors.affiliation: Department on Organisation of Medicines Provision, Ministry of Health, Minsk, Belarus.
authors.forename: Galina
authors.initials: G
authors.lastname: Pyshnik
authors.affiliation: Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina.
authors.forename: Tijana
authors.initials: T
authors.lastname: Spasojevic
authors.affiliation: JSC "My family Clinic", Tbilisi, Georgia.
authors.forename: Irma
authors.initials: I
authors.lastname: Korinteli
authors.affiliation: National Institute of Public Health of Kosovo and Faculty of Medicine, University of Pristina, Pristina, Kosovo.
authors.forename: Lul
authors.initials: L
authors.lastname: Raka
authors.affiliation: CitiHope International, Bishkek, Kyrgyzstan.
authors.forename: Baktygul
authors.initials: B
authors.lastname: Kambaralieva
authors.affiliation: Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro.
authors.forename: Lidija
authors.initials: L
authors.lastname: Cizmovic
authors.affiliation: Agency of Medicines, Chisinau, Moldova.
authors.forename: Angela
authors.initials: A
authors.lastname: Carp
authors.affiliation: Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia.
authors.forename: Vesela
authors.initials: V
authors.lastname: Radonjic
authors.affiliation: Avicenna Tajik State Medical University, Dushanbe, Tajikistan.
authors.forename: Nargis
authors.initials: N
authors.lastname: Maqsudova
authors.affiliation: Ministry of Health of Turkey, Turkish Medicines and Medical Devices Agency, Ankara, Turkey.
authors.forename: Hatice Demet
authors.initials: HD
authors.lastname: Celik
authors.affiliation: Croatian Committee for Antibiotic Resistance Surveillance, Croatian Academy for Medical Sciences, Zagreb, Croatia.
authors.forename: Marina
authors.initials: M
authors.lastname: Payerl-Pal
authors.affiliation: Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Hanne Bak
authors.initials: HB
authors.lastname: Pedersen
authors.affiliation: Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: Sautenkova
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium. Electronic address: herman.goossens@uza.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005061:Europe, Eastern; D005062:European Union; D006801:Humans; D014944:World Health Organization
chemical_list: D000900:Anti-Bacterial Agents