[Prescription and use of antibiotics in ambulatory care. Drug Agency].

OBJECTIVE: This study was conducted to describe changes in prescription practices outside the hospital, to evaluate the adaptation of such prescriptions to current scientific knowledge, and to compare medical practices in France with those in other European countries.

METHODS: Data were collected from several sources: analysis of the literature, surveys conducted in the Loiret department and in the Rhone-Alps region, ten-year healt surveys (INSEE), data from the Sentinel network, sales statements from pharmaceutical firms, the Permanent Survey of Medical Prescription (EPPM) of the Medical Information and Statistics (IMS) firm. Comparisons between France, the United Kingdom and Germany were conducted by the French Medicine Agency's Pharmaco-economic Studies and Information Department using data furnished by the IMS firm and by pharmaceutical firms.

RESULTS: In France, antibiotic sales increased by a mean annual rate of 2.1%, expressed in antibiotic units, and 2.6%, expressed in turnover (manufacturer price) between 1991 and 1996. The majority of these antibiotics were prescribed for respiratory and ENT infections with a presumed viral etiology such as rhino-pharyngitis and acute bronchitis. The results of the different surveys were in agreement showing that antibiotic prescriptions are made in approximately 40% of all consultations for rhino-pharyngitis and in 80% of those for acute bronchitis. Antibiotics were prescribed in more than 90% of cases of pharyngitis whatever the age of the patient. The situation was different for acute middle ear infections as the number of consultations has remained relatively unchanged over the last 10 years while antibiotic prescriptions have strongly increased, reaching 80% of the consultations. The number of consultations for pharyngitis and acute rhino-pharyngitis appears to be greater in France than in the United Kingdom and in Germany. Likewise, the proportion of patients using antibiotics after consulting for presumed viral conditions would be higher in France with different antibiotic classes being used.

CONCLUSIONS: There is a gap between official guidelines (product description documents, therapeutic information documents, good practice guidelines, consensus conferences) and the state of current practices. Excessive and poorly-adapted antibiotic prescription favors the disturbing phenomenon of resistance which is all the more alarming because the emergence of resistant strains is difficult to predict and concerns bacteria causing the most common infections. To improve medical practices and achieve a persistent reduction in the use of antibiotics for viral infections, validated recommendations should be distributed to physicians. An effort should be made to prescribe the most appropriate active substance at optimal dose and treatment duration to limit the development of bacterial resistance. In addition, patients and the general public should be informed of the absence of any beneficial effect and the individual and collective risks involved in using antibiotics for viral infections in order to help them better understand and comply to their physician's prescription.