title: The correlation between regulatory conditions and antibiotic consumption within the WHO European Region.
abstract: BACKGROUND
  In a global perspective, bacterial infections are still a major cause of morbidity and mortality; therefore, effective antibiotics are needed. However, the emergence of antibiotic resistance due to irrational use has now become a serious public health problem. Hence, the objective of this study was to analyse the association of regulatory aspects with antibiotic consumption.
  
  
  METHODS
  A data set representing 20 countries throughout the WHO European Region was chosen based on data availability so as to analyse the correlation between specific regulatory conditions and antibiotic consumption, using total consumption data for 2011 and information about national provisions regarding rational use of medicines. Linear regression models were designed in order to evaluate individual aspects as well as the overall level of regulation.
  
  
  RESULTS
  A high level of regulation, assessed by an overall index, was significantly correlated with lower antibiotic consumption; however, of all individual items analysed, only the presence of Standard Treatment Guidelines for hospital care as well as paediatric conditions, the non-availability of antibiotics without a prescription, and the existence of training modules for pharmacists covering rational use of medicines gave significant results, i.e. lower use of antibiotics, when regarded in isolation.
  
  
  CONCLUSIONS
  Although national regulatory conditions intended to foster rational use of antibiotics seem to be correlated with antibiotic consumption, this association is potentially influenced by a wide range of contextual aspects.
authors.affiliation: Faculty of Medicine, Lund University, Clinical Research Centre, Jan Waldenströms Gata 35, SE-205 02 Malmö Sweden. Electronic address: tanjasmueller@gmail.com.
authors.forename: Tanja
authors.initials: T
authors.lastname: Mueller
authors.affiliation: Faculty of Medicine, Lund University, Clinical Research Centre, Jan Waldenströms Gata 35, SE-205 02 Malmö Sweden. Electronic address: per-olof.ostergren@med.lu.se.
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Östergren
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D004352:Drug Resistance, Microbial / Q000187:drug effects; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe; D014943:Global Health; D033161:Government Regulation; D006801:Humans; D010595:Pharmacists; D063487:Prescription Drug Misuse
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Antibiotic stewardship; Antibiotics; Rational use of medicines