Abstract
BackgroundIn 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”.Materials and MethodsTo 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).ResultsMedia 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.ConclusionThe 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.
Highlights
During the last few decades, the emergence and dissemination of multidrug-resistant bacterial strains have become a major public health issue worldwide [1,2]
No effect on total outpatient antibiotic consumption was observed during the whole mediatic period
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
Summary
During the last few decades, the emergence and dissemination of multidrug-resistant bacterial strains have become a major public health issue worldwide [1,2]. Doctors have been prescribing (and patients have been demanding) antibiotics for viral respiratory infections, eg colds and influenza, even though antibiotics do not cure viral infections [3,4] This overuse of antibiotics has been the main driving force in the spread of multiresistant bacteria. In the 2000s, the highest European rate of S. pneumoniae antibiotic resistance was observed in France, which has one of the highest rates of community antibiotic consumption, more than three-fold higher than the Netherlands [5,6]. To fight against this overuse, the French government launched, in 2001, a national program ‘‘Keep antibiotics working’’. We first determined the period when media coverage was high, and compared, during this period, observed outpatient antibiotic consumption to estimated outpatient antibiotic consumption ‘‘without media attention’’
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