Abstract
The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient–doctor interaction as major factors among healthcare providers. We further discuss initiatives that, if taken and implemented, can have an impact on and improve the current situation in Europe.
Highlights
We present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient–doctor interaction as major factors among healthcare providers
What is the current situation of antibiotic use and resistance in Europe? How did the situation change during recent years? What are the differences between European countries? What are the commonly discussed factors driving irrational antibiotic use in Europe in the community and among healthcare providers (HCPs)?
In order to respond to the research questions, we performed a broad search of the current literature using the following databases: PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on broadly discussed drivers of irrational antibiotic use in Europe
Summary
Antibiotics are one of the most cost-effective, life-saving medicines and contribute to an extended lifespan [1]. A key driver of ABR is the irrational use of antibiotics. In 2016, antibiotic consumption for systemic use in the community (i.e., outside hospitals) in Greece was 36.3 defined daily doses (DDD) per 1000 inhabitants per day (DDD/TID). ESAC-Net data showed a higher proportion of use of cephalosporins, other beta-lactams (including carbapenems), and other groups of antibiotics in hospitals compared to use in the community [5]. Drug-resistant infections lead to approximately 700,000 deaths per year globally. This is projected to increase to 10 million by. In the European Union (EU) alone, 25,000 patients die due to infections caused by multiresistant bacteria, costing society approximately €1.5 billion annually.
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