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      Self-medication with Antimicrobial Drugs in Europe

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      * , , * , * , , , § , , # , ** , †† , ‡‡ , §§ , ¶¶ , ## , *** , ††† , ‡‡‡ , §§§ , ¶¶¶ , ### , ****
      Emerging Infectious Diseases
      Centers for Disease Control and Prevention
      Self-medication, antimicrobial agents, cross-sectional studies, Europe, drug resistance, bacterial, drug utilization, research

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          Abstract

          Antimicrobial drug self-medication occurs most often in eastern and southern Europe and least often in northern and western Europe.

          Abstract

          We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug self-medication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000–3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public.

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          Most cited references28

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          Antibiotic Selection Pressure and Resistance in Streptococcus pneumoniae and Streptococcus pyogenes

          We correlated outpatient antibiotic use with prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP), macrolide-resistant S. pneumoniae (MRSP), and macrolide-resistant S. pyogenes (MRGAS) in 20 countries. Total antibiotic use was correlated with PNSP (r = 0.75; p < 0.001), as was macrolide use with MRSP (r = 0.88; p < 0.001) and MRGAS (r = 0.71; p = 0.004). Streptococcal resistance is directly associated with antibiotic selection pressure on a national level.
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            Bacterial resistance: origins, epidemiology, and impact.

            The basic mechanisms of antibacterial resistance are well known, but critical new aspects continue to be discovered. Recently discovered factors with major implications for the emergence, dissemination, and maintenance of resistance include multidrug efflux, hypermutability, integrons, and plasmid addiction. Some resistances are widespread and others local, with prevalence rates often worst in newly prosperous countries and in those specialist units where antibacterial use is heaviest. Multidrug-resistant epidemic strains are critical to the total accumulation of resistance (e.g., among Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae), but it remains unclear why some bacterial lineages achieve epidemic spread whereas others that are equally resistant do not. The correlation between in vitro resistance and treatment failure is imperfect, but resistance undoubtedly increases mortality, morbidity, and costs in many settings. Recent concern has led to a plethora of governmental and agency reports advocating less antibacterial use, better antibacterial use, better infection control, and the development of new antibacterials. The evidence that better prescribing can reduce resistance rates is mixed, and although changes to hospital regimens may reduce one resistance problem, other opportunistic bacteria may fill the vacant niche. Overall, the best that can reasonably be anticipated is an improved balance between the accumulation of resistance and new antibacterial development.
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              Antimicrobial Resistance Determinants and Future Control

              At the beginning of the 21st century, antimicrobial resistance is common, has developed against every class of antimicrobial drug, and appears to be spreading into new clinical niches. We describe determinants likely to influence the future epidemiology and health impact of antimicrobial-resistant infections. Understanding these factors will ultimately optimize preventive strategies for an unpredictable future.
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                Author and article information

                Journal
                Emerg Infect Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                March 2006
                : 12
                : 3
                : 452-459
                Affiliations
                [* ]University Medical Center Groningen, Groningen, the Netherlands;
                []University of Linz, Linz, Austria;
                []Vrije Universiteit Brussel, Brussels, Belgium;
                [§ ]University Hospital for Infectious Diseases, Zagreb, Croatia;
                []Charles University, Prague, Czech Republic;
                [# ]Statens Serum Institut, Copenhagen, Denmark;
                [** ]Health Protection Surveillance Centre, Dublin, Ireland;
                [†† ]Consorzio Mario Negri Sud, Chieti, Italy;
                [‡‡ ]Ha'Emek Medical Center, Afula, Israel;
                [§§ ]Institute of Hygiene, Vilnius, Lithuania;
                [¶¶ ]Directorate of Health, Luxembourg, Luxembourg;
                [## ]St Luke's Hospital, G'Mangia, Malta;
                [*** ]National Institute of Public Health, Warsaw, Poland;
                [††† ]Max Planck Institute for Demographic Research, Rostock, Germany;
                [‡‡‡ ]Comenius University, Bratislava, Slovakia;
                [§§§ ]University Medical Centre, Ljubljana, Slovenia;
                [¶¶¶ ]Instituto de Salud Carlos III, Madrid, Spain;
                [### ]Karolinska Institutet, Göteborg, Sweden;
                [**** ]Nottingham City Hospital, Nottingham, United Kingdom
                Author notes
                Address for correspondence to: Larissa Grigoryan, Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, the Netherlands; fax: 31-50-3632812; email: l.grigoryan@ 123456med.umcg.nl
                Article
                05-0992
                10.3201/eid1203.050992
                3291450
                16704784
                5a610d2f-da68-4720-9f7c-b5ab8961cf22
                History
                Categories
                Research
                Research

                Infectious disease & Microbiology
                self-medication,antimicrobial agents,cross-sectional studies,europe,drug resistance,bacterial,drug utilization,research

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