Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe.

Background There are no reliable data on antibiotic use in non-European Union (EU) southern and eastern European countries and newly independent states. We aimed to collect valid, representative, comparable data on systemic antimicrobial use in these non-EU countries of the WHO European region. Methods Validated 2011 total national wholesale antibiotic-use data of six southern and eastern European countries and regions and seven newly independent states were analysed in accordance with the WHO anatomical therapeutic chemical (ATC)/defined daily doses (DDD) method and expressed in DDD/1000 inhabitants per day (DID). Findings Total (outpatients and hospital care) antibiotic use ranged from 15-3 DID for Armenia to 42-3 DID for Turkey. Co-amoxidav was mainly used in Georgia (42.9% of total antibiotic use) and Turkey (30.7%). Newly independent states used substantial quantities of ampicillin and amoxicillin (up to 55.9% of total antibiotic use in Azerbaijan). Montenegro and Serbia were the highest consumers of macrolides (15-8% and 19.5% of total antibiotic use, respectively), mainly azithromydn. Parenteral antibiotic treatment is common practice: 46.4% of total antibiotic use in Azerbaijan (mainly ampicillin; 5.3 DID) and 31.1% of total antibiotic use in Tajikistan (mainly ceftriaxone; 4.7 DID). Interpretation This study provides publicly available total antibiotic-use data for 13 non-EU countries and areas of the WHO European region. These data will raise awareness of inappropriate antibiotic use and stimulate policy makers to develop action plans. The established surveillance system provides a method to develop quality indicators of antibiotic use and to assess the effect of policy and regulatory actions. Copyright (c) 2014. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.