European Surveillance of Antimicrobial Consumption (ESAC): Outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe (1997-2009)

Niels Adriaenssens, Samuel Coenen, Ann Versporten, Arno Muller, Girma Minalu, Christel Faes, Vanessa Vankerckhoven, Marc Aerts, Niel Hens, Geert Molenberghs, Herman Goossens, Sigrid Metz, Gerhard Fluch, Sofie Vaerenberg, Mathijs Michiel Goossens, Boyka Markova, Arjana Tambic Andrašević, Antonis Kontemeniotis, Jiří Vlček, Niels Frimodt-MøllerUlrich Stab Jensen, Ly Rootslane, Ott Laius, Jaana Vuopio-Varkila, Outi Lyytikainen, Philippe Cavalie, Winfried Kern, Helen Giamarellou, Anastasia Antoniadou, Gábor Ternák, Ria Benko, Haraldur Briem, Olafur Einarsson, Robert Cunney, Ajay Oza, Raul Raz, Hana Edelstein, Pietro Folino, Andis Seilis, Uga Dumpis, Rolanda Valinteliene, Marcel Bruch, Michael Borg, Peter Zarb, Stephanie Natsch, Marieke Kwint, Hege Salvesen Blix, Waleria Hryniewics, Anna Olczak-Pienkowska, Malgorzata Kravanja, Tomasz Ozorowski, Mafalda Ribeirinho, Luis Caldeira, Anda Bǎicuş, Gabriel Popescu, Svetlana Ratchina, Roman Kozlov, Viliam Foltán, Milan Čižman, Edurne Lázaro, José Campos, Francisco de Abajo, Ulrica Dohnhammar, Giorgio Zanetti, Peter Davey, Hayley Wickens

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Background: Data on more than a decade of outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe were collected from 33 countries within the European Surveillance of Antimicrobial Consumption (ESAC) project, funded by the European Centre for Disease Prevention and Control (ECDC), using the WHO Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Methods: For the period 1997-2009, data on outpatient use of systemic MLS aggregated at the level of the active substance were collected and expressed in DDD (WHO, version 2011) per 1000 inhabitants per day (DID). Using a classification based on mean plasma elimination half-life, macrolide use was analysed for trends over time, seasonal variation and composition. Results: Total outpatient MLS use in 2009 varied by a factor of 18 between the countries with highest (11.5 DID in Greece) and lowest (0.6 DID in Sweden) use. MLS use showed high seasonal variation. Short-, intermediateand long-acting macrolides were the most commonly used agents in 2, 25 and 5 countries, respectively (mainly erythromycin, clarithromycin and azithromycin, respectively). In Sweden, mainly lincosamides (clindamycin) were used. Lincosamide use was observed in all countries, while substantial use of a streptogramin was only seen in France (pristinamycin). For Europe, a significant increase in outpatient MLS use was found, as well as a significant seasonal variation, which increased over time from 1997 to 2009. Relative use of longacting macrolides and lincosamides significantly increased over time with respect to intermediate-acting macrolides, and relative use of the latter increased with respect to short-acting macrolides. Conclusions: The observed differences between European countries in the levels of MLS use and the extreme seasonal variations in their use suggest that this subgroup of antibiotics is still prescribed inappropriately in many countries.

Original languageEnglish
Article numberdkr456
Pages (from-to)vi37-vi45
JournalJournal of Antimicrobial Chemotherapy
Issue numberSUPPL. 6
Publication statusPublished - Dec 1 2011


  • Ambulatory care
  • Antibiotic use
  • Drug consumption
  • Pharmacoepidemiology

ASJC Scopus subject areas

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

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    Adriaenssens, N., Coenen, S., Versporten, A., Muller, A., Minalu, G., Faes, C., Vankerckhoven, V., Aerts, M., Hens, N., Molenberghs, G., Goossens, H., Metz, S., Fluch, G., Vaerenberg, S., Goossens, M. M., Markova, B., Andrašević, A. T., Kontemeniotis, A., Vlček, J., ... Wickens, H. (2011). European Surveillance of Antimicrobial Consumption (ESAC): Outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe (1997-2009). Journal of Antimicrobial Chemotherapy, 66(SUPPL. 6), vi37-vi45. [dkr456].