欧洲抗菌药物消耗监测网（ESAC）：1997-2009 年欧洲门诊大环内酯类、林可酰胺类和链阳菌素类（MLS）药物使用情况。

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

机构信息

Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.

出版信息

J Antimicrob Chemother. 2011 Dec;66 Suppl 6:vi37-45. doi: 10.1093/jac/dkr456.

DOI:10.1093/jac/dkr456

PMID:22096065

Abstract

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-, intermediate- and 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 long-acting 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.

摘要

背景

欧洲监测抗生素消费项目（ESAC）由欧洲疾病预防控制中心（ECDC）资助，采用世界卫生组织（WHO）解剖学治疗化学（ATC）/限定日剂量（DDD）方法，从欧洲 33 个国家收集了超过 10 年的门诊大环内酯类、林可酰胺类和链阳菌素类（MLS）药物使用数据。

方法

在 1997-2009 年期间，按活性物质汇总了系统使用 MLS 的门诊数据，并以每日每千名居民 DDD（WHO，2011 年版）表示。根据平均血浆消除半衰期分类，对不同时间、季节性变化和组成的大环内酯类药物使用趋势进行了分析。

结果

2009 年各国门诊 MLS 总使用量差异高达 18 倍，使用量最高的国家（希腊 11.5 DDD）和最低的国家（瑞典 0.6 DDD）相差 18 倍。MLS 使用具有明显的季节性变化。短效、中效和长效大环内酯类药物分别在 2、25 和 5 个国家中最常使用（主要分别为红霉素、克拉霉素和阿奇霉素）。在瑞典，主要使用林可酰胺类药物（克林霉素）。所有国家都使用林可酰胺类药物，而只有法国（普林霉素）大量使用链阳菌素类药物。对于整个欧洲，门诊 MLS 使用量呈显著增加趋势，同时季节性变化也随时间推移而增加，从 1997 年到 2009 年不断增加。与中效大环内酯类药物相比，长效大环内酯类和林可酰胺类药物的相对使用量呈上升趋势，而中效大环内酯类药物的相对使用量则呈上升趋势。