Hospital use of antibiotics varies threefold across EuropeBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7552.1234-c (Published 25 May 2006) Cite this as: BMJ 2006;332:1234
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Roger Dobson commented (1) a recent article on the use of antibiotics
in hospital across Europe by the European Surveillance Consumption Project
Group(2). Italy was not included in this project; however, in a recent
national project for the study of the prevalence of nosocomial infections
(INFNOS) in 15 hospitals, with four point-prevalence surveys in three
years, we collected striking data on antibiotic consumption in the
First of all, density of prescription in our country was
higher than that reported in the European Surveillance Group, i.e. 5.5 DDD
x 1000 patients. As a proportion, penicillin and beta-lactams other than
cephalosporins and carbapenems, accounted for 27% of prescriptions.
Second, on average 45% of in-patients had at least one antibiotic during
the prevalence surveys with no variation in the 3-year study. Third, a
quarter of patients were receiving at least one antibiotic without any
evidence of infection, excluding the surgical perioperative prophylaxis.
This proportion was similar to that reported (29.6%) between October and
December, 2000 in a region wide prevalence survey in North of Italy on 59
hospital facilities with about 16,000 beds, 560,000 admission yearly, and
9,467 patients surveyed (4).
Surveillance of antibiotic consumption in the hospital setting is
essential for several purposes including appropriate use of
antimicrobials, reduction of the impact on resistance, and cost savings.
An antibiotic policy in the hospital setting should provide guidelines and
recommendations for the implementation of educational programmes on use of
antimicrobial agents. Moreover, there is a need for the establishment of
antibiotic audits for an evidence-based and standardized use of
antimicrobials. Additionally, those procedures that need and do not need
antimicrobial prophylaxis should be clearly identified on the basis of the
evidence available in the literature. Finally, when necessary, antibiotic
restriction programmes or antibiotic cycling strategies should be adopted.
Acknowledgment. INFNOS study was supported by GlaxoSmithKline s.p.a.,
1. Dobson R. Hospital use of antibiotics varies threefold across
Europe. BMJ 2006; 332: 1234.
2. Vander Stichele RH, Elseviers MM, Ferech M, et al. Hospital
consumption of antibiotics in 15 European countries: results of the ESAC
Retrospective Data Collection (1997-2002). J Antimicrob Chemother 2006,
3. Porretta A, Giuliani L, Vegni FE, Larosa M, Privitera G; INF-NOS
Study Group. Prevalence and patterns of antibiotic prescribing in Italian
hospitals. Infection 2003;31 Suppl 2:16-21.
4. Zotti CM, Messori Ioli G, Charrier L, et al. Hospital-acquired
infections in Italy: a region wide prevalence study. J Hosp Infect 2004;
Competing interests: No competing interests