European Journal of Clinical Pharmacology

, Volume 62, Issue 5, pp 373–379 | Cite as

National campaigns to improve antibiotic use

  • Herman Goossens
  • Didier Guillemot
  • Matus Ferech
  • Benoit Schlemmer
  • Michiel Costers
  • Marije van Breda
  • Lee J. Baker
  • Otto Cars
  • Peter G. Davey
Pharmacoepidemiology and Prescription


High levels of antibiotic consumption are driving levels of bacterial resistance that threaten public health. Nonetheless, antibiotics still provide highly effective treatments for common diseases with important implications for human health. The challenge for public education is to achieve a meaningful reduction in unnecessary antibiotic use without adversely affecting the management of bacterial infections. This paper focuses on the lessons learned from national campaigns in countries (Belgium and France) with high antibiotic use. Evaluation of these national campaigns showed the importance of television advertising as a powerful medium to change attitudes and perhaps also behaviour with regard to antibiotics. Moreover, in both countries, strong evidence suggested reduced antibiotic prescribing. However, adverse effects associated with a reduction in antibiotic prescribing were not monitored. We conclude that carefully designed mass education campaigns could improve antibiotic use nationally and should be considered in countries with high antibiotic use. However, these campaigns should employ techniques of social marketing and use appropriate outcome measures. The benefits and risks of such campaigns have been less well established in countries where antibiotic use is already low or declining.


Antibiotics Bacterial Drug resistance Drug utilization Education Health promotion 


  1. 1.
    Nordberg P, Monnet DL, Cars O (2004) Antibacterial resistance. Background document for the WHO project: Priority medicines for Europe and the World-a public health approach to innovation. World Health Organization, Geneva. (Available at, accessed 23 Nov 2005)
  2. 2.
    Goossens H, Ferech M, Stichele RV, Elseviers M, the ESAC Project Group (2005) Outpatient antibiotic use in Europe and association with resistance. Lancet 365:579–587PubMedGoogle Scholar
  3. 3.
    Grilli R, Freemantle N, Minozzi S, Domenighetti G, Finer D (1997) Mass media interventions: effects on health services utilisation (Cochrane Review). The Cochrane Library 2001 (Issue 1). Update Software, OxfordGoogle Scholar
  4. 4.
    Person B, Cotton D (1996) A model of community mobilization for the prevention of HIV in women and infants. Prevention of HIV in women and infants demonstration projects. Public Health Rep 111(suppl 1):89–98PubMedGoogle Scholar
  5. 5.
    Bavestrello L, Cabello A (2004) Impact of regulatory measures on antibiotic sales in Chile. 2nd international conference on improving use of medicines, 30 March-2 April 2004, Chiang Mai, Thailand. (accessed 8 Dec 2004)
  6. 6.
    Park S (2004) Decreased inappropriate antibiotic use following a Korean National Policy to prohibit medication dispensing by physicians. 2nd international conference on improving use of medicines, 30 March-2 April 2004, Chiang Mai, Thailand. (accessed 23 Nov 2005)
  7. 7.
    Bauraind I, Lopez-Lozano JM, Beyaert A, Marchal JL, Seys B, Yane F et al (2004) Association between antibiotic sales and public campaigns for their appropriate use. JAMA 292:2468–2470PubMedCrossRefGoogle Scholar
  8. 8.
    Aubry Damon H, Carlet J, Courvalin P, Desenclos JC, Drucker J, Guillemot D et al (2000) Bacterial resistance to antibiotics in France: a public health priority. Euro Surveill 5:135–138PubMedGoogle Scholar
  9. 9.
    Sommet A, Sermet C, Boelle PY, Tafflet M, Bernede C, Guillemot D (2004) No significant decrease in antibiotic use from 1992 to 2000, in the French community. J Antimicrob Chemother 54:524–528PubMedCrossRefGoogle Scholar
  10. 10.
    Plan national pour préserver l’efficacité des antibiotiques (2001) Paris; Ministère de la santé et des solidarités (Available at, accessed 23 Nov 2005)
  11. 11.
    Mackson J (2004) Implementation and outcomes of a 5-year intervention program to improve use of antibiotics in respiratory tract infections in primary care. 2nd international conference on improving use of medicines, 30 March-2 April 2004, Chiang Mai, Thailand. (accessed 23 Nov 2005)
  12. 12.
    Cars O, Stålsby Lundborg C, Mölstad S (2004) Improving antibiotic use through a nationwide decentralized project-a nine-year experience. 2nd international conference on improving use of medicines, 30 March-2 April 2004, Chiang Mai, Thailand., 2004 (accessed 23 Nov 2005)
  13. 13.
    Ashworth M, Latinovic R, Charlton J, Cox K, Rowlands G, Gulliford M (2004) Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the general practice research database. J Pub Health 26:268–274CrossRefGoogle Scholar
  14. 14.
    Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D (2002) Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharmacol Therapeut 27:299–309CrossRefGoogle Scholar
  15. 15.
    Guillemot D, Henriet L, Lecoeur H, Weber P, Carbon C (2001) Optimization of antibiotic use rapidly decreases penicillin resistant Streptococcus pneumoniae (PRSP) carriage: The AUBEPPIN Study (Abstract 1527). In: Abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, 16–19 Dec, 2001, Chicago, Ill. American Society for Microbiology, Washington, DC, p 264Google Scholar
  16. 16.
    Guillemot D, Varon E, Bernede C, Weber P, Henriet L, Simon S et al (2005) Reduction of antibiotic use in the community reduces the rate of colonization with penicillin G-nonsusceptible Streptococcus pneumoniae. Clin Infect Dis 41:930–938PubMedCrossRefGoogle Scholar
  17. 17.
    Donnan PT, Wei L, Steinke DT, Phillips G, Clark R, Noone A (2004) Presence of bacteriuria caused by trimethoprim resistant bacteria in patients prescribed antibiotics: multilevel model with practice and individual patient data. BMJ 328:1295–1300CrossRefGoogle Scholar
  18. 18.
    Wilson P (2004) Commentary: legal issues of data anonymisation in research. BMJ 328:1300–1301PubMedCrossRefGoogle Scholar
  19. 19.
    Van Zuijlen DA, Schilder AG, Van Balen FA, Hoes AW (2001) National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media. Pediatr Infect Dis J 20:140–144PubMedCrossRefGoogle Scholar
  20. 20.
    Little P, Watson L, Morgan S, Williamson I (2002) Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study. Br J Gen Pract 52:187–190, 193PubMedGoogle Scholar
  21. 21.
    Price DB, Honeybourne D, Little P, Mayon-White RT, Read RC, Thomas M et al (2004) Community-acquired pneumonia mortality: a potential link to antibiotic prescribing trends in general practice. Resp Med 98:17–24CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Herman Goossens
    • 1
  • Didier Guillemot
    • 2
  • Matus Ferech
    • 1
  • Benoit Schlemmer
    • 3
  • Michiel Costers
    • 4
  • Marije van Breda
    • 4
  • Lee J. Baker
    • 5
  • Otto Cars
    • 6
  • Peter G. Davey
    • 7
  1. 1.Laboratory of Medical MicrobiologyUniversity of AntwerpAntwerpBelgium
  2. 2.Resource Center of Biostatistics, Epidemiology and Pharmacoepidemiology Applied to Infectious DiseasesInstitut PasteurParisBordeauxFranceFrance
  3. 3.Department de Réanimation MedicaleSaint-Louis University HospitalParisFrance
  4. 4.BAPCOC Federal Public Service of Public Health, Food Chain and EnvironmentBrusselsBelgium
  5. 5.ChesterUK
  6. 6.Swedish Institute for Infectious Diseases ControlSolnaSweden
  7. 7.Health Informatics CentreDundee UniversityDundeeUK

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