Education And Debate

# Regulating the use of antibiotics in the community

BMJ 1998; 317 (Published 05 September 1998) Cite this as: BMJ 1998;317:663
1. Claude Carbon, chief of internal medicinea,
2. Richard P Bax, director of research and developmentb
1. aHospital Bichat, Claude Bernard, 75877 Paris Cedex 18, France
2. bSmithKline Beecham Pharmaceuticals, New Frontiers Science Park South, Harlow, Essex CM19 5AW
1. Correspondence to: Professor Carbon claude.carbon@bch.ap-hop.paris.fr

All parties perceive antibiotic resistance as a global threat.1 We examined the literature on the use of antibiotics in the community to establish how the issue of antibiotic resistance might be managed. We chose illustrative examples from recent important publications.

#### Summary points

• Political measures to control costs of antibiotic use generally have had a short term effect without affecting resistance

• Although the reversibility of the current situation of resistance is unknown, actions that could decrease the volume of antibiotic use without affecting quality of care should be considered

• General practitioners should help to set guidelines for selecting patients to be treated; improved treatment schedules must be researched and put into practice

• The clinical evaluation of antibiotics must be improved — to show effectiveness and effects on the ecology of resistance, as well as safety and efficacy

• The pharmaceutical industry, microbiology physicians, academia, regulators, policymakers, and healthcare providers should participate in managing the issue of antibiotic resistance

## Costs

The world market for antibiotics in 1997 was $17bn (£10.6bn), of which$12bn was for community use, with about 818 billion prescriptions for respiratory tract infections. Although the value is rising (the 1993 market was \$15bn), the number of prescriptions is now static. From 1980 to 1991, however, the overall increase in prescriptions for antibiotics in England was 46%—but still below the rate of growth over the same period in France. 2 3

Several factors may influence the increase in antibiotic costs. 1 3 4 Recently, two characteristics of antibiotics prescribing — that is, use of doses that are too small or treatments that are too long — have been shown to increase the risk of selection of resistance.5 The ecological impact of poor compliance or of the use of highly selective agents remains to be established.

Respiratory tract infection accounts for …

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