European Surveillance of Antimicrobial Consumption (ESAC): Outpatient quinolone 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 Bǎicus, Gabriel Popescu, Svetlana Ratchina, Roman Kozlov, Viliam Foltán, Milan Cižman, 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 quinolone use were collected from 33 European countries within the European Surveillance of Antimicrobial Consumption (ESAC) project, funded by the European Centre for Disease Prevention and Control (ECDC). Methods: For the period 1997-2009, data on outpatient use of systemic quinolones aggregated at the level of the active substance were collected using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) method (WHO, version 2011), and expressed in DDD and packages per 1000 inhabitants per day (DID and PID, respectively). Using a classification based on pharmacokinetic and in vitro potency profiles, quinolone use was analysed with regard to trends over time, seasonal variation and composition. Results: Total outpatient quinolone use in 2009 varied by a factor of 7.5 between the country with the highest (Italy, 3.61 DID) and the country with the lowest (the UK, 0.48 DID) quinolone use. The second-generation quinolones accounted for .50% of quinolone use (mainly ciprofloxacin), except for Croatia, where first-generation quinolones (mainly norfloxacin) were mostly used. A significant increase in outpatient quinolone use was found for Europe, as well as a large seasonal variation, which increased significantly over time from 1997 to 2009. Relative use of third-generation quinolones significantly increased over time with respect to the use of second-generation quinolones, while the relative use of both significantly increased with respect to the firstgeneration quinolones. Levofloxacin and moxifloxacin (respiratory quinolones) represented .10% of quinolone outpatient use in 17 countries, with extreme seasonal variation in all countries. Conclusions: There was a substantial increase and change in the pattern of quinolone use between 1997 and 2009, a period during which quinolones that are effective for the treatment of respiratory tract infections were introduced. These quinolones are not the first-line antibiotics for this indication and their use should generally be limited, and quinolones should ideally show no substantial seasonal variation in terms of their use.

Original languageEnglish
Article numberdkr457
Pages (from-to)vi47-vi56
JournalJournal of Antimicrobial Chemotherapy
Issue numberSUPPL. 6
Publication statusPublished - dec. 2011

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 quinolone use in Europe (1997-2009). Journal of Antimicrobial Chemotherapy, 66(SUPPL. 6), vi47-vi56. [dkr457].