Dear David,
Last year, as part of my MPH-degree I digged deep into the literature on
antibiotics whilst writing a thesis on impact of guidelines and surveillance
on the use of antibiotics in a large university hospital. Separately, I'm
sending you some of the references I have, the list could be extended a lot
if you wish. Unfortunately, many of my references is on hospital use (which
is only 10-20% of all human use), except for the ones on resistance, and
mainly for so-called developed countries.
Most of the recent literature on use and impact of different restrictions
etc. quote very old (20 year) references to document misuse and overuse. I
find that, except for articles on relationship between use and resistance,
little has been done recently to document overuse/misuse except to find that
by making formularies, introduce surveillance, use antibiotic order forms,
etc. use will very often be reduced. And in the prophylactic use of
antibotics in surgery, I think it is clearly documented that there is overuse.
Coming from a part of the world with low use and still small problems of
resistance, it is also tempting to conclude that others are using too much
or the wrong antibiotics. Also, comparison between countries, as shown in
some of the references I'm sending, indicates that there are major
differences and that the countries using most has the biggest problems of
resistance.
Many of the references are on successful initiatives to reduce
over-prescribing so I will not go in detail here. In addition, I have seen
from small notices in Scrip last year that France has had much success by
introducing national guidelines for general practice.
In addition to what I could send you in a language you would understand, the
Medical Journals of the Nordic countries in 1995 and 1996 carried quite a
lot of articles in national languages on problems of resistant pneumococci
in kindergartens in Finland and Iceland due to over/misuse,
vancomycin-resistant enterococci in Finland due to over/misuse and import
from other countries. Problem now spreading to Sweden whilst we still only
have had a couple of patients (which I think came from Sweden). Further,
antibiotic use in animal feed is a hot topic and we are definitely not happy
with EU here (fortunately Norway is still not a member!)
As for anecdotes, When i was in Mongolia last year, they used about four to
five different sulpha drugs for diarrhoea as well as streptomycin,
penicillin in eyedrops and nosedrops, benzylpenicillin for a variety of
diseases, even rheumatic disorderas, gentamycin for UTI's and other
non-hospital use etc. Often, patients purchased without prescription,
several antibiotics and usually only 10 tablets.
I hope this is of some assistance.
Best regards Kirsten
Ms Kirsten Myhr, MScPharm, MPH
Bygdoy Alle 58B
0265 Oslo
Norway
Tel: +47 22 56 05 85 (h)
Fax: +47 22 24 90 17 (w) Tel: +47 22 24 90 39 (w)
E-mail: myhr@online.no
or (w): kirsten.myhr@helsetilsynet.dep.telemax.no
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