Belgian National Antibiotic Awareness Campaigns Herman Goossens, Stijn De Corte, Samuel Coenen University of Antwerp and BAPCOC Joris Mateusen, Sarah Tulkens Absoluut Belgium
Belgian National Antibiotic Awareness Campaigns When: since November 2000, annually during winter season Organised by: BAPCOC (Belgian Antibiotic Policy Coordination Committee) Budget: About 400,000 EUR/annual campaign Interventions targeting the public: Ads on TV, radio and newspaper Information booklets Folders Posters Internet campaigns: www.antibiotics-info.be
Belgian National Public Campaigns I & II 2000-2003 2004-2008
Evaluation of the Belgian National Public Campaigns Process evaluation Impact evaluation the awareness of the public the appreciation of the campaigns by the GPs AB prescription at the community level (ESAC) Cost/saving Outcome evaluation antibiotic resistance in the community Did the campaigns have an impact on knowledge, attitude and behaviour?
Assessment of Attitude and Behaviour of Public and Ambulatory Care Prescribers Public: Method: - face-to-face interviews (n=1,015), pre- and 1-2.5 months after first campaign Results: - 79% remembered campaign through TV spots - Use too much: 38%; bugs become resistant: 12% - Agree to use less antibiotics in agreement with GP: 75% (P<0.05) Ambulatory Care Prescribers: Method: - telephone interviews (n=400), 3 months after first and second campaign Results: - Already 100% remembered first campaign - What: should use less AB, 81% / bugs become resistant, 8% - How: prescribed less antibiotics: 32% (first) to 63% (second campaign) - Only intended at cutting social security costs: 32 (first) to 29% (second campaign) - Should be repeated: 70% (first) to 75% (second campaign)
GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe). 2006-2011 WP 8: qualitative interview study in 9 European countries of factors contributing to variation in antibiotic use and resistance in primary care WP Leader: Chris Butler, University of Cardiff, Wales, UK Question related to Change in patient expectations Antwerp: Change in patient expectations But to most of the people who do understand it, you almost don t have to explain it anymore, because there have been so many campaigns, here in Belgium, that most of the people, er, are starting to understand after all, gradually (QH0049) "that government campaign against antibiotics, that sure is terrific, because before that you really had to put a lot more energy in the people, and now, the young people, they are all up-to-date uh [ ] They really come in and say like: if it is not necessary, no antibiotics, uh. Like that uh, that s really easy (QH0035) www.grace-lrti.org
Variation of DDD delivered (%) beyond model predictions Impact of First Two National Campaigns in Belgium 0 2000-2001 campaign 2001-2002 campaign "one fits to final analysis" - 7.03 % - 6.53 % - 0.79 % - 3.41 % - 5 "one model for all analyses" Significant effect : in December : - 15.0 % Significant effect : in February : - 14.7 % Bauraind et al., 2004, JAMA 2004. Global AB consumption change attributed to intervention : - 5.01 % p = 0.012
DDD/1000 inh./day Outpatient Antibiotic Use in Belgium Defined Daily Doses per 1,000 Inhabitants per day 1997 2007, July to June 30 25 20 15 10 Other J01 classes Sulfonamides and trimethoprim (J01E) Quinolones (J01M) Macrolides, lincosamides and streptogramins (J01F) Tetracyclines (J01A) Cephalosporins and other beta-lactams (J01D) Penicillins (J01C) 5 0 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07
Packages/1000 inh./day Outpatient Antibiotic Use in Belgium Packages per 1,000 Inhabitants per day 1997 2007, July to June 4 3.5-1.0% -3.4% -6.4% -36% 3 2.5 2 1.5-9.1% -6.9% -7.5% -3.8% -3.6% -5.3% Other J01 classes Sulfonamides and trimethoprim (J01E) Quinolones (J01M) Macrolides, lincosamides and streptogramins (J01F) Tetracyclines (J01A) Cephalosporins and other beta-lactams (J01D) Penicillins (J01C) 1 0.5 0 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07
Antibiotic use in Packages/1,000 inh./day (PID) Quarterly UK Countries and Belgium Davey et al (2008). J Antimicrob Chemother Epub ahead of print
Percentage Antibiotic Resistance of S. pneumoniae in Belgium. 1995-2007 40 35 penig tetra erythro ofloxacine 30 25 20 15 10 5 0 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 1 2 3 4 5 6 7 Year National Reference Centre S. pneumoniae (University of Leuven)
percentage Antibiotic Resistance of Throat Isolates of S. pyogenes in Belgium. 2002 2007 18 erythromycin 16 14 12 10 8 6 4 2 0 2002 2003 2004 2005 2006 2007 year National Reference Centre S. pyogenes (University of Antwerp)
EUR, miljoenen Outpatient Antibiotic Use in EUR, 1997-2006 250 State Patients 200 150 100 52 170 53 178 52 174 50 169 46 153 45 146 44 139 39 42 123 122 38 108 50 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Conclusions Belgian national antibiotic awareness campaigns have been very successful to reduce antibiotic use and resistance Huge cost savings: for 1 invested, about 10 were saved Decrease of antibiotic use amplified by the effect of the 7 valent conjugated pneumococcal vaccine Furthermore, actions were also directed towards the prescribers: academic detailing distribution of guidelines individual feed-back of antibiotic prescriptions The burden of antibiotic resistance warrants a multifaceted approach