Are antibiotics still “automatic” in France?

Abstract

The first part of a series of three features on antimicrobial resistance looks the French campaign that has been held up as an example of how to change the way antibiotics are prescribed. But, as Gary Humphreys reports, 10 years after the campaign's launch France is still one of Europe's biggest consumers of antibiotics and trends are moving in the wrong direction. Dr Pierre Fayn recalls the effect a 2002 French National Health Insurance campaign promoting better-targeted antibiotic use had on the children of Cleon d'Andran, a sleepy village in the Drome in south-eastern France. I would start by explaining to the parent why there was no need to treat the little one's cold with an antibiotic, and the child would chant: Because 'antibiotics are not automatic They knew the catchphrase; he says with a grin. The catchphrase--Les antibiotiques, c'est pas automatique--was in fact the title of the campaign first launched in 2002 with the aim of decreasing antibiotic prescription in France by 25% over a period of five years. In particular, the campaign targeted the treatment of viral respiratory infections in children, for whom 40% of the prescriptions were being written. Since 2002 the campaign has been repeated every winter for the duration of the viral respiratory infections epidemic season. The campaign was part of a broader government initiative rolled out in 2001 and called Keep Antibiotics Working--a multi-pronged plan that included the promotion of streptococcal rapid antigen testing and treatment guidelines among health-care professionals and the targeting of primary care physicians in one-on-one tutorials. At the time of the 2002 launch, France was consuming more antibiotics than any other country in Europe and facing a burgeoning antimicrobial resistance problem, notably with multidrug-resistant Streptococcus pneumoniae, a bacterium that colonizes the nose and throat and can cause problems that range from mild ear infections to life-threatening pneumonia and is especially dangerous for young children and elderly people. It has been known ever since antibiotics were developed that using them improperly leads to bacterial resistance, and overuse of antibiotics only increases that risk. The threat of widespread antimicrobial resistance raises the spectre of a world without effective antibiotics, where a patient can die from an infection once regarded as banal and easily treatable. The World Health Organization is devoting the next World Health Day on 7 April 2011 to raising awareness around the issue. France is one of 22 high-income whose measures to reduce antibiotic usage between 1990 and 2007 are assessed in a study by Dr Benedikt Hutmer and colleagues that was published in The Lancet in January 2010. They found that campaigns that were formally assessed, like the French one, seemed to reduce the use of antibiotics in outpatients at least in high-prescribing countries According to a study published in PLoS Medicine in June 2009, the French campaign exceeded expectations with a 26.5% reduction in the number of antibiotic prescriptions over the first five years. Though by no means the first to achieve significant results--yearly mass media campaigns in Belgium have been credited with a 36% reduction in antibiotic prescriptions between 1999 and 2000 and 2006 and 2007, for example--the French campaign is often held up as a model. For Professor Benoit Schlemmer, president of the government-appointed Keep Antibiotics Working committee, while the achievements of the French campaign are undeniable, nine years after its launch there are still major concerns about the way the French prescribe and consume antibiotics. For one thing France remains close to the top of Europe's antibiotic consumer league table, trailing super-prescribers Greece and Cyprus, although Schlemmer says league tables are of little interest to him. …