INSERM, U 657, Paris, France.
PLoS One. 2013 Jul 24;8(7):e69075. doi: 10.1371/journal.pone.0069075. Print 2013.
In France, the 2009 A(H1N1) influenza epidemic occurred between September 2009 and January 2010. Sparking widespread controversy, it was intensely reported in the media. Despite therapeutic inefficacy, antibiotic consumption and viral respiratory infections are positively correlated, particularly in France, where antibiotic overconsumption is well-known. We first determined the period when media coverage was high, and then compared, during this period, observed outpatient antibiotic consumption to estimated outpatient antibiotic consumption "without media attention".
TO EVALUATE MEDIA COVERAGE, TWO ONLINE DATABASES WERE CONSULTED: Factiva and Europresse. To quantify outpatient antibiotic consumption, we used data on reimbursements of outpatient systemic antibiotics from the computerized databases of the two main National Health Insurance agencies. Influenza-like syndromes data came from the French GPs Sentinelles Network. Weekly time-series of antibiotic consumption were modeled by autoregressive moving-average models with exogenous inputs and interventions. Analyses were computed for the entire series and by age group (0-5, 6-15, 16-60, and >60 years).
Media coverage was intense between April 2009 and January 2010. No effect on total outpatient antibiotic consumption was observed during the whole mediatic period. However, during the epidemic in France (September 2009-January 2010), we found an antibiotic underconsumption for the entire series, 0-5 and >60 years. Additionally, at the beginning of the pandemic, when cases were still outside France (June 2009-August 2009), we found an antibiotic overconsumption for patients >16 years.
The early period of A(H1N1) virus circulation compared with seasonal influenza or an overdeclaration of ILS cases might explain the antibiotic underconsumption observed during the period of active A(H1N1) virus transmission in France. At the pandemic onset, when uncertainty was high, the overconsumption observed for individuals >16 years might have been caused by alarmist media reporting. Additional analyses are needed to understand the determinants of antibiotic consumption during this period.
2009 年法国发生了甲型 H1N1 流感疫情，从 2009 年 9 月持续到 2010 年 1 月。这场疫情引起了广泛的争议，媒体对此进行了大量报道。尽管治疗效果不佳，但抗生素的使用与病毒性呼吸道感染呈正相关，尤其是在抗生素滥用现象严重的法国。我们首先确定了媒体关注度较高的时期，然后在该时期内，将观察到的门诊抗生素使用量与“没有媒体关注”时的估计门诊抗生素使用量进行了比较。
为了评估媒体报道，我们查阅了两个在线数据库：Factiva 和 Europresse。为了量化门诊抗生素的使用量，我们使用了来自两个主要国家健康保险机构的计算机化数据库中有关门诊全身抗生素报销的数据。流感样综合征数据来自法国全科医生 Sentinelles 网络。通过带有外部输入和干预措施的自回归移动平均模型对每周抗生素使用量时间序列进行建模。分析是针对整个系列和不同年龄组（0-5 岁、6-15 岁、16-60 岁和>60 岁）进行的。
媒体报道在 2009 年 4 月至 2010 年 1 月期间非常密集。在整个媒体报道期间，并未观察到总门诊抗生素使用量的变化。然而，在法国的疫情期间（2009 年 9 月至 2010 年 1 月），我们发现整个系列、0-5 岁和>60 岁年龄组的抗生素使用不足。此外，在大流行的早期，当病例仍在法国境外时（2009 年 6 月至 8 月），我们发现 16 岁以上患者的抗生素使用过量。
与季节性流感或 ILS 病例的过度申报相比，甲型 H1N1 病毒传播的早期阶段可能解释了法国在甲型 H1N1 病毒传播活跃期间观察到的抗生素使用不足的情况。在大流行开始时，由于不确定性很高，观察到 16 岁以上人群的抗生素使用过量可能是由于媒体的恐慌性报道所致。需要进一步分析以了解这段时间抗生素使用量的决定因素。
