title: Antibiotic use varies substantially among adults: a cross-national study from five European Countries in the ARITMO project.
abstract: OBJECTIVE
  To examine patterns of outpatient and community antibiotic use among adults in five European countries.
  
  
  METHODS
  We used healthcare data of 28.8 million adults from six population-based ARITMO project databases to ascertain information on systemic antibiotic use in Denmark (2000-2008), the Netherlands (1999-2010), Italy (2000-2010), the UK (1996-2009), and Germany (2004-2008). We estimated overall, and age-group and sex specific antibiotic use as defined daily doses (DDD) per 1000 inhabitants per day. We computed annual age- and sex-standardized population prevalence of antibiotic use per 1000 persons-years (p-y) and the mean duration (in days) of antibiotic use.
  
  
  RESULTS
  The overall antibiotic use varied from 8.7 DDD per 1000 inhabitants per day in the UK to 18.1 DDD in Denmark, representing a 2.1-fold geographical variation. In all countries, prescribing was relatively high among individuals aged 15-19 years; lower in those aged 20-50 years; and then increased steadily reaching 41.8 DDD per 1000 inhabitants per day in individuals ≥ 85 years in Denmark. After age- and sex-standardization, prevalence of antibiotic use varied threefold from 160.2/1000 p-y in the UK to 421.1/1000 p-y in Italy. The ratio of broad- to narrow-spectrum penicillin, cephalosporin, and macrolide use varied from 0.6 in Denmark to 120.2 in Italy. Women used more antibiotics than men did in all countries. Across countries, the mean duration of antibiotic use varied 1.3 to 21.1-fold for different antibiotics.
  
  
  CONCLUSIONS
  Antibiotic use is high in women and the elderly. Prescribing patterns vary substantially across European countries, both according to overall consumption, user prevalence, duration, and narrow- versus broad-spectrum antibiotics.
authors.affiliation: Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus N, 8200, Aarhus, Denmark, anil.mor@clin.au.dk.
authors.forename: Anil
authors.initials: A
authors.lastname: Mor
authors.forename: Trine
authors.initials: T
authors.lastname: Frøslev
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.forename: Alessandro
authors.initials: A
authors.lastname: Oteri
authors.forename: Peter
authors.initials: P
authors.lastname: Rijnbeek
authors.forename: Tania
authors.initials: T
authors.lastname: Schink
authors.forename: Edeltraut
authors.initials: E
authors.lastname: Garbe
authors.forename: Serena
authors.initials: S
authors.lastname: Pecchioli
authors.forename: Francesco
authors.initials: F
authors.lastname: Innocenti
authors.forename: Irene
authors.initials: I
authors.lastname: Bezemer
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Sturkenboom
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
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