Greece has highest use of antibiotics outside hospital in Europe

BMJ 2012; 345 doi: (Published 20 November 2012) Cite this as: BMJ 2012;345:e7871
  1. Rory Watson
  1. 1Brussels

European institutions, researchers, and the medical and veterinary professions are combining forces to raise awareness of the dangers of misusing antibiotics. Representatives of all were present in Brussels on 16 November when the European Centre for Disease Prevention and Control presented its latest data on the degree of antibiotic resistance in Europe.1

The data show wide disparities across the European Union in the use of antibiotics outside hospitals. Such use is highest in Greece, whose rate is almost four times that in Estonia, the EU country with the lowest consumption. Presenting the findings, the centre’s director, Marc Sprenger, said, “There has been a Europe-wide increase of antibiotic resistance and of multidrug resistance in Gram negative bacteria such as Klebsiella pneumonia and Escherichia coli.”

The data confirm that consumption of carbapenems, a major last line of antibiotics, rose significantly in 16 EU countries from 2007 to 2010. In this group, too, resistance is increasing. In just one year the proportion of resistant isolates from bloodstream infections rose from 15% to 27% in Italy and from 49% to 68% in Greece.

The research shows that the incidence of meticillin resistant Staphylococcus aureus (MRSA) has decreased or stabilised in most EU countries. The United Kingdom, with national programmes to tackle MRSA in hospitals, recorded the largest reduction from 2008 to 2011. However, the proportion of S aureus isolates found to be resistant to meticillin reached 25% in a quarter of the countries surveyed, and resistance was particularly high in southeastern Europe.

Paola Testori Coggi, the European Commission’s director general for health and consumers, highlighted the human and financial costs of MRSA: 25 000 deaths a year and an additional bill of €1.5bn (£1.2bn; $1.9bn) to health services.

She said, “We need to tackle the problem in a comprehensive approach, in which all relevant parties and stakeholders live up to their responsibility to combat this serious threat in their respective areas.” That approach involved prudent use of antibiotics in human and veterinary medicine, developing new antimicrobial products, and preventing infections, she said.

Robert-Jan Smits, the commission’s director general for research, confirmed that in addition to the €600m that the EU had already allocated to efforts to tackle antimicrobial resistance since 1999, it planned to launch a call for tender for two new projects in the coming weeks. The funding is designed to reverse the fall in the number of companies developing antibiotics—from 19 in 1990 to four.

Representing the Standing Committee of European Doctors, Mads Koch Hansen called on the commission to examine the feasibility of drawing up European clinical guidelines for treating specific diseases with antimicrobials. He supported moves to ensure that antibiotics could be obtained only with a prescription, not over the counter, and pressed for legislation to separate veterinarians’ rights to prescribe and sell antibiotics.

Christophe Buhot, president of the Federation of Veterinarians of Europe, rejected the proposed split but confirmed that the federation was impressing on its 200 000 members the importance of responsible use of antibiotics.


Cite this as: BMJ 2012;345:e7871