European surveillance of antimicrobial consumption (ESAC): Outpatient parenteral antibiotic treatment in Europe

Samuel Coenen, Arno Muller, Niels Adriaenssens, Vanessa Vankerckhoven, Erik Hendrickx, Herman Goossens, Helmut Mittermayer, Herman Goossens, Boyka Markova, Arjana Andraŝevic, Antonis Kontemeniotis, Vlĉek Jir̂í, Niels Frimodt-Møller, Ly Rootslane, Pentti Huovinen, Philippe Cavalié, Winfried Kern, Helen Giamarellou, Gábor Ternák, Karl KristinssonRobert Cunney, Raul Raz, Pietro Folino, Uga Dumpis, Roland Valinteliene, Marcel Bruch, Michael Borg, Margreet Filius, Salvesen Blix Hege, Waleria Hryniewicz, Mafalda Ribeirinho, Anda Baçicus, Svetlana Ratchina, Viliam Foltán, Milan Cizíman, José Campos, Gunilla Skoog, Giorgio Zanetti, Serhat Ünal, Peter Davey

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Objectives: To assess the proportion of parenteral treatment of the total outpatient antibiotic use in Europe, and to identify the antibiotic groups and individual antibiotics most commonly administered in this way. Methods: Within the European Surveillance of Antimicrobial Consumption (ESAC;, using the anatomic therapeutic chemical (ATC) and defined daily dose (DDD) classification, data on outpatient use of antibacterials for systemic use (ATC J01), aggregated at the level of the active substance and expressed in DDD per 1000 inhabitants per day (DID; WHO version 2007), were extracted for 2006 by route of administration and by country. Parenteral use was expressed as a percentage of the total outpatient use in DID. Results: In 20 European countries, the total outpatient antibiotic use ranged from 27.91 DID in France to 9.58 DID in Russia. The proportion of outpatient parenteral antibiotic treatment ranged from 6.75% in Russia to 0.001% in Iceland. The three most commonly used antibiotic groups for parenteral treatment in Europe were the cephalosporins (J01D; 44.58%), the aminoglycosides (J01G; 25.27%) and the penicillins (J01C; 17.78%). Four antibiotics [gentamicin (J01GB03) 18.53%; ceftriaxone (J01DD04) 17.85%; cefazolin (J01DB04) 13.16%; and lincomycin (J01FF02) 5.47%] represented more than half of the use. Conclusions: In all 20 European countries studied together, 2.04% of outpatient antibiotics were used for parenteral treatment. However, as for the total outpatient antibiotic use and the use of different antibiotic groups and antibiotics, there is a striking variation in the proportions of parenteral antibiotic use in Europe. More in-depth data on outpatient antibiotic use are needed to explain this variation.

Original languageEnglish
Pages (from-to)200-205
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Issue number1
Publication statusPublished - Jun 22 2009



  • Ambulatory care
  • Antibiotic use
  • Drug consumption
  • Pharmaco epidemiology
  • Route of administration

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Coenen, S., Muller, A., Adriaenssens, N., Vankerckhoven, V., Hendrickx, E., Goossens, H., Mittermayer, H., Goossens, H., Markova, B., Andraŝevic, A., Kontemeniotis, A., Jir̂í, V., Frimodt-Møller, N., Rootslane, L., Huovinen, P., Cavalié, P., Kern, W., Giamarellou, H., Ternák, G., ... Davey, P. (2009). European surveillance of antimicrobial consumption (ESAC): Outpatient parenteral antibiotic treatment in Europe. Journal of Antimicrobial Chemotherapy, 64(1), 200-205.