Outpatient Antibiotic Use and Prevalence of Antibiotic-Resistant Pneumococci in France and Germany: A Sociocultural Perspective

Stephan Harbarth, Werner Albrich, Christian Brun-Buisson


Emerging Infectious Diseases. 2002;8(12) 

In This Article

Abstract and Introduction

The prevalence of penicillin-nonsusceptible pneumococci is sharply divided between France (43%) and Germany (7%). These differences may be explained on different levels: antibiotic-prescribing practices for respiratory tract infections; patient-demand factors and health-belief differences; social determinants, including differing child-care practices; and differences in regulatory practices. Understanding these determinants is crucial for the success of possible interventions. Finally, we emphasize the overarching importance of a sociocultural approach to preventing antibiotic resistance in the community.

The epidemiology of antibiotic-resistant Streptococcus pneumoniae varies tremendously between different countries and continents[1]. In Europe, high rates of penicillin-resistant pneumococci have been recorded in France and Spain, whereas countries like Germany and Switzerland are only marginally affected[2,3]. The reasons for the uneven geographic distribution of antibiotic-resistant pneumococci are not fully understood.

In this article, we focus on a comparison of pneumococcal resistance rates between Germany and France, two neighboring European countries with well-developed health-care systems accessible for virtually the entire population. Moreover, living standards, expenditures on health, and key survival statistics (infant deaths, life expectancy) are roughly equivalent, which allowed us to assume that at least in terms of general health indicators both countries could be judged to be comparable[4]. We reviewed recent epidemiologic data about antibiotic resistance in clinically relevant pneumococcal isolates of patients in Germany and France and explored different hypotheses to explain the observed differences between the two countries. The main questions addressed are: 1) Do important differences exist in antibiotic-prescribing practices in the outpatient setting? 2) Do the factors influencing decisions on antibiotic use differ? 3) Are these differences related to sociocultural and other macro-level determinants? In particular, we sought to offer potential methods for future international comparisons designed to aid in developing effective strategies for decreasing the spread of antibiotic-resistant microorganisms in the community.


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