Inventory of antibiotic stewardship programs in general practice in France and abroad.
OBJECTIVE
The authors conducted a survey of measures implemented in France and abroad for a better use of antibiotics in general practice.


METHODS
A literature review was conducted from January 2000 to July 2014. Emails were sent to every infectious diseases department, to all regional health authorities (ARS), to the health insurance offices (CPAM) with the highest and lowest antibiotic use, and to the ministry of health to make an inventory of all antibiotic stewardship programs. The ministry of health, the board of general practitioners, infectious diseases specialists, pharmacists, and the medical and pharmacy schools of the nation's capital were contacted in 17 countries of Europe and North America.


RESULTS
The main measures implemented in France were training of healthcare professionals, publishing guidelines, feedback to the practitioners on their prescriptions, and availability of rapid diagnostic tests. Telephone networks were created in some regions, such as Antibiolor or Medqual, to help physicians with antibiotic prescription. Many foreign countries issued pedagogical material to physicians, for patients to explain what to do in case of viral infection or delayed prescription. In Alberta (Canada), the government introduced an optional authorization for quinolones. In Denmark, the government temporarily suspended the reimbursement of some agents to preserve them according to bacterial ecology. In the United-Kingdom, the antibiotic susceptibility test report must include less than 5 agents.


CONCLUSIONS
The measures implemented in France and abroad were usually more persuasive than restrictive. But the bacterial resistance crisis should lead to implementing more restrictive measures.
Antibiolor, bâtiment des spécialités médicales Philippe-Canton, CHU de Nancy-Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France. Electronic address: dr.wang.sophie@gmail.com.
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Wang
Antibiolor, bâtiment des spécialités médicales Philippe-Canton, CHU de Nancy-Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Service de maladies infectieuses, CHU de Nancy-Hôpitaux de Brabois, allée du Morvan, 54511 Vandœuvre-Lès-Nancy cedex, France; EA 4360 Apemac, université de Lorraine, université Paris-Descartes, 9, avenue de la Forêt-de-Haye, CS 50184, 54505 Vandœuvre-lès-Nancy cedex, France.
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Pulcini
Antibiolor, bâtiment des spécialités médicales Philippe-Canton, CHU de Nancy-Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France; Service de maladies infectieuses, CHU de Nancy-Hôpitaux de Brabois, allée du Morvan, 54511 Vandœuvre-Lès-Nancy cedex, France.
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Rabaud
CIC-P Inserm, CHU de Nancy, Hôpital Brabois, bâtiment Louis Mathieu, 54500 Vandœuvre-Lès-Nancy, France; Département de médecine générale, faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Forêt-de-Haye, BP 184, 54505 Vandœuvre-Lès-Nancy cedex, France.
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Boivin
Antibiolor, bâtiment des spécialités médicales Philippe-Canton, CHU de Nancy-Hôpitaux de Brabois, 54511 Vandœuvre-lès-Nancy cedex, France.
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Birgé
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D002170:Canada; D004346:Drug Information Services; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005060:Europe; D005602:France; D058006:General Practice / Q000706:statistics & numerical data*; D006078:Government Programs; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
D000900:Anti-Bacterial Agents
Antibiotics; Antibiotiques; Bon usage; General practice; Misuse; Médecine générale; Mésusage; Stewardship