Variation in antibiotic use in the European Union
Abstract
Data on antibiotic use are not publicly available in most European Union countries. We obtained data for non-hospital antibiotic sales for 1997 from the 15 member states and analysed these according to the Anatomic Therapeutic Chemical classification system, and expressed them as defined daily doses per 1000 people per day. Sales of antibiotics varied more than four-fold: France (36.5), Spain (32.4), Portugal (28.8), and Belgium (26.7) had the highest sales, whereas the Netherlands (8.9), Denmark (11.3), Sweden (13.5), and Germany (13.6) had the lowest. There was also profound variation in use of different classes of antibiotics. Detailed knowledge of antibiotic use is necessary to implement national strategies for optimum antibiotic use, and to address the threat posed by resistant microorganisms.
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In a cross-national study by Cars et al. in 2001 in Sweden, only 30% of individuals discontinued antibiotics due to symptom relief.
“However, in high-income countries like Sweden, a cross-national study by Cars et al. in 2001 reported that only 30% of individuals discontinued antibiotics due to symptom relief [10].”
From Understanding Antimicrobial Self-Medication Practices in the Andaman and Nicobar Islands in India (2025) · cites this paper as [10]
Cites
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Self-citationMelander, E., Ekdahl, K., J??NSSON, G., & LSTAD, S. M. (2000) · The Pediatric Infectious Disease Journal · doi:10.1097/00006454-200012000-00011 · Cited by 112 · see citing works
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Outpatient antibiotic use in Europe and association with resistance: a cross-national database study
Goossens, H., Ferech, M., Vander Stichele, R., & Elseviers, M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)17907-0 · Cited by 3,359 · see citing works
Hicks, L. A., Bartoces, M. G., Roberts, R. M., Suda, K. J., Hunkler, R. J., Taylor, T. H., & Schrag, S. J. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ076 · Cited by 559 · see citing works
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Elong Ekambi, G.-A., Okalla Ebongue, C., Penda, I. C., Nnanga Nga, E., Mpondo Mpondo, E., & Eboumbou Moukoko, C. E. (2019) · PLOS ONE · doi:10.1371/journal.pone.0212875 · Cited by 128 · see citing works
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Choice of Comparator in Active Control Trials of New Drugs
Luijn, J. C. V., Loenen, A. C. V., Gribnau, F. W., & Leufkens, H. G. (2008) · Annals of Pharmacotherapy · doi:10.1345/aph.1l115 · Cited by 21 · see citing works
Understanding Antimicrobial Self-Medication Practices in the Andaman and Nicobar Islands in India
Sridhar, Y., Anand, A., Sethuraman, A., & Hossain, S. (2025) · Cureus · doi:10.7759/cureus.80473 · Cited by 1 · see citing works
“However, in high-income countries like Sweden, a cross-national study by Cars et al. in 2001 reported that only 30% of individuals discontinued antibiotics due to symptom relief [10].”
- Authors
- Cars, O., Mölstad, S., & Melander, A.
- Affiliations
- Uppsala University Hospital (SE)
- Swedish Institute (SE)
- Corresponding author
- Cars, Otto
- ORCID
- Cars, Otto
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2001-06
- Volume
- 357
- Issue
- 9271
- Pages
- 1851-1853
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1983742247
- Cited by
- 698
- References
- 2
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 7 · 2021: 16 · 2020: 10 · 2019: 15 · 2018: 15 · 2017: 19 · 2016: 13 · 2015: 19 · 2014: 24 · 2013: 11 · 2012: 30
- FWCI
- 54.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Keywords
- antibiotic use, antibiotic sales, defined daily doses, intercountry variation, EU member states, ATC classification, antibiotic resistance, antimicrobial stewardship, public health policy
- MeSH terms
- Anti-Bacterial Agents, Cross-Cultural Comparison, Drug Utilization, Europe, European Union, Humans
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