Research Article: “Antibiotics Are Not Automatic Anymore”—The French National Campaign To Cut Antibiotic Overuse

Date Published: June 2, 2009

Publisher: Public Library of Science

Author(s): Benedikt Huttner, Stephan Harbarth

Abstract: Benedikt Huttner and Stephan Harbarth discuss the implications of a new study that examined the impact of a national campaign in France to reduce antibiotic overuse.

Partial Text: Antibiotic resistance is an important public health concern [1]. Antibiotics are one of the most commonly prescribed drug classes worldwide, with considerable variation in outpatient antibiotic use between countries [2]. Viral respiratory tract infections drive antibiotic overprescribing in the outpatient setting, and this overprescribing is also influenced by patient demand and expectations [3],[4].

In a new study published in this issue of PLoS Medicine, Didier Guillemot and colleagues analyze the impact of a similar campaign in France, which used to be known for the highest rates of antibiotic use and pneumococcal resistance in Europe [8],[9]. In 2001, French policy makers and public health authorities launched a coordinated and multifaceted strategy for the control of antimicrobial resistance. One of the key interventions was a yearly campaign targeting the public via mass media, conveying the message that “Antibiotics Are Not Automatic” (especially for viral respiratory tract infections). Simultaneously, the streptococcal rapid antigen test and treatment guidelines were promoted among health care professionals. A substantial number of primary care physicians were targeted by one-on-one educational sessions known as “academic detailing”.

This study provides the largest and most sophisticated analysis published thus far correlating a nationwide public campaign to decreased antibiotic use over an extended period of time. The researchers address many potential sources of bias and confounding [10].

Guillemot and colleagues report that developing and conducting the campaign cost 500 million euros over six years, which seems extremely costly considering that the Belgian campaign cost only about 400,000 euros per year [7]. But without more detailed cost-benefit analyses, this cost information should be interpreted with caution. It is, however, noteworthy that the reduction in antibiotic costs in France outweighed the cost of the public campaign to reduce prescribing.

Overall, the results of the French public campaign are very encouraging and confirm those of the Belgian campaign: in countries with high baseline antibiotic use, sustained and multifaceted campaigns using mass media as well as targeting physicians can decrease antibiotic use substantially. Nonetheless, given the variations in antibiotic usage patterns, sociocultural determinants, and health care systems, different approaches are warranted for different countries [3]. Future campaign managers are certainly well-advised to apply social marketing concepts to identify the optimal approach for their own country [14]. We should not forget, however, that some national campaigns (e.g., Greece, Spain, England, Australia) failed to show a major impact on antibiotic prescriptions, although few of these data have been published [15],[16]. On the other hand, Sweden succeeded in reducing antibiotic use by a comprehensive program without a public campaign component [17].

Since the ultimate goal of any campaign to reduce antibiotic use is to curb antibiotic resistance, more longitudinal and modeling studies are needed. Realistically, these studies may require individual patient data from small-scale surveillance networks, including monitoring of potential adverse effects of reduced prescribing.



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