Changes in the use of antibacterial drugs in the countries of central and eastern Europe

Abstract

Use of systemic antibacterial drugs in the countries of central and eastern Europe (CCEE) has been studied using the defined daily doses (DDD) methodology. For the comparison, national wholesale data from Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Slovenia and Romania for the years 1989 and 1992 were used, i.e. for the years before and after the rapid sociopolitical changes in these countries. Substantial differences in the patterns of antibacterial drug use between countries as geographically and economically similar as the CCEE were observed. The general sales of antibiotics varied almost twofold among the CCEE and had decreased in most of the CCEE during the study period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum penicillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spectrum penicillins varied within the range of 4% in Bulgaria to 38% in Slovakia, and had decreased during the study years in all countries. Aminoglycosides accounted for 5–12% of all antibacterials in Bulgaria, Estonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumption of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ranked among the top ten drugs in all countries studied. All countries had their specific preferences in the top ten lists, but the rationality of these traditions can be questioned: tetracycline + oleandomycin in Bulgaria; penamecillin in the Czech Republic and Hungary; sulphonamides in Estonia and Lithuania; and benzathine penicillin and streptomycin in Slovakia. The international differences in antibiotic utilization are suggested to be related to the respective health care systems (e.g. drug reimbursement) and prescribing preferences (e.g. therapeutic traditions), quite apart from possible differences in drug efficacy, drug tolerance and the prevalence and severity of various infections.