de Neeling A J, Overbeek B P, Horrevorts A M, Ligtvoet E E, Goettsch W G
National Institute of Public Health and the Environment, Bilthoven. Leeuwarden, Nijmegen and Haarlem, The Netherlands.
J Antimicrob Chemother. 2001 Sep;48(3):441-4. doi: 10.1093/jac/48.3.441.
Antibiotic use in The Netherlands during the period 1994-1999 is described in relation to the resistance of routine isolates of Streptococcus pneumoniae. The average antibiotic use in the study period was 3.4 defined daily doses per 1000 persons per day (DDD/1000/day) penicillins, 0.066 DDD/1000/day beta-lactams other than penicillins, 2.3 DDD/1000/day tetracyclines and 0.71 DDD/1000/day trimethoprim and sulphonamides, without apparent rise or decline. In contrast, the use of macrolides doubled from 0.51 DDD/1000/day in 1994 to 1.0 DDD/1000/day in 1997 and stayed at 1.07 DDD/1000/day in 1998 and 1999. In 1994 the first pneumococci isolated from patients showed 0.7% resistance to penicillin (intermediate plus full resistance), 2.5% to erythromycin, 4.2% to co-trimoxazole and 4.7% to tetracycline. In 1999 first isolates showed 1.5% resistance to penicillin, 3.8% to erythromycin, 4.4% to co-trimoxazole and 6.6% to tetracycline. The modest but significant rise in the resistance to erythromycin may have been caused by the increased use of macrolides in the years 1994-1997. The rise in resistance to penicillin seemed not to be related to increased beta-lactam use.
本文描述了1994年至1999年期间荷兰抗生素的使用情况及其与肺炎链球菌常规分离株耐药性的关系。研究期间，青霉素的平均使用量为每1000人每天3.4限定日剂量（DDD/1000/天），非青霉素类β-内酰胺类抗生素为0.066 DDD/1000/天，四环素为2.3 DDD/1000/天，甲氧苄啶和磺胺类药物为0.71 DDD/1000/天，使用量无明显增减。相比之下，大环内酯类药物的使用量从1994年的0.51 DDD/1000/天增加了一倍，至1997年达到1.0 DDD/1000/天，并在1998年和1999年保持在1.07 DDD/1000/天。1994年从患者中分离出的首批肺炎球菌对青霉素（中介加完全耐药）的耐药率为0.7%，对红霉素为2.5%，对复方新诺明为4.2%，对四环素为4.7%。1999年首批分离株对青霉素的耐药率为1.5%，对红霉素为3.8%，对复方新诺明为4.4%，对四环素为6.6%。1994 - 1997年期间大环内酯类药物使用量的增加可能导致了对红霉素耐药性的适度但显著上升。青霉素耐药性的上升似乎与β-内酰胺类药物使用量的增加无关。
