Europe

In the comparative studies from countries in Europe there are no national data on indications for prescribing, dose, or duration of treatment. However there are some studies on diagnosis for prescriptions in outpatient care.

In the West Midlands General Practice Research Database, United Kingdom, there was between 1993 and 1997 an overall decrease in prescribing from 963 to 807 prescriptions per 1,000 patients and year (Frischer et al.,

2001). Non-specific lower respiratory tract infections and throat infections accounted for the main decreases in antibiotic prescribing.

In Norway, the most commonly recorded diagnosis was urinary tract infections, followed by acute bronchitis, ear infections, and non-specific upper respiratory tract infections in 1989 (Straand, 1998). The most prescribed antibiotics were narrow-spectrum penicillins (29%), followed by tetracyclines (24%), trimethoprim-sulfamethoxazole (17%), and erythromycin (12%). Narrowspectrum penicillin was used in a majority of ear infections, tonsillitis, nonspecific upper respiratory tract infections and sinusitis. Tetracyclines were most often prescribed for acute bronchitis and pneumonia and trimethoprim-sulfamethoxazole for urinary tract infections.

In Sweden, a 1-week survey on 7,700 visits for infectious diseases in five counties was conducted in the year 2000 (Stalsby et al., 2002). Respiratory tract infections accounted for 70% of the diagnoses, of which 54% were prescribed an antibiotic, of which narrow-spectrum penicillin accounted for 62% of prescriptions, followed by tetracycline (14%). Most cases of acute otitis media and acute tonsillitis were prescribed narrow-spectrum penicillin. In acute bronchitis, 50% of cases were prescribed an antibiotic, of which tetracy-cline was the most common followed by narrow-spectrum penicillin and amoxicillin. In urinary tract infections, trimethoprim, pivmecillinam, and fluo-roquinolones accounted for one third each. About 50% of skin and soft tissue infections were treated with isoxazolylpenicillins whereas cefalosporins were used in 12%.

In Finland, indications for antibiotic prescribing has been studied in a point prevalence study conducted in 30 Health Centres (Rautakorpi et al., 2001). A total of 7,800 visits for infections were recorded. The most common cause for a visit was a respriratory tract infection (74%), followed by skin/wound infections and urinary tract infections (both 6%). Of the otitis media, 53% were treated with amoxicillin, 16% with a macrolide, and 16% with co-trimoxazole. Patients with acute bronchitis received antibiotic treatment in 70% of cases, mostly macrolides (39%) and doxycycline (36%).

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