Use of antibiotics among community-dwelling adults in Germany -Results of National Health Interview and Examination Surveys 1997 – 1999 and 2008 – 2011

Background: Antimicrobial resistance is a rising global public health threat. Overuse and inappropriate use of antibiotics are thought to contribute greatly to the emergence of antimicrobial resistance. The WHO and European Commission have initialized action plans on antimicrobial resistance, emphasizing the monitoring of antimicrobial use at national levels [1, 2]. Using data of national health surveys we investigate antibiotic use among community-dwelling adults aiming to identify regional differences and temporal trends in antibiotic use over time.

Methods: Study subjects were 18 – 79 year-old participants of German National Health Interview and Examination Surveys 1997 – 1999 (GNHIES98, N = 7099) and 2008 – 2011 (DEGS1, N = 7091). All drugs used in the past 7 days prior to the medical interview were documented. A medication with an ATC code J01 was considered as antibiotics for systemic use. SPSS complex sample module was used for analyses. Both GNHIES98 and DEGS1 results were weighted and standardized to the population of 31.12.2010.

Results: Prevalence of antibiotic use decreased significantly (p = 0.009) overall from 2.3% in 1997 – 1999 to 1.5% in 2008 – 2011. A significant reduction in antibiotic use was found among women (2.8%-1.9%), in the age group < 60 years (2.5%-1.6%), people residing in cities (2.4%-1.5%), former West Germany (2.5%-1.6%), from lower social class (2.6%-1.3%), doing no sports (2.7%-1.4%), smokers (2.7%-1.1%) and overweight persons (2.7%-0.9%) (all prevalence GNHIES98-DESG1, p < 0.05). Multivariable logistic analyses revealed that in GNHIES98 antibiotic use was associated with women (adjusted odds ratio 1.89, 95% confidence intervals 1.16 – 3.08), people < 60 years (2.01, 1.16 – 3.48) and residing in West Germany (1.64, 1.10 – 2.46), while in DEGS1 this was found only among women (1.67, 1.00 – 2.80). In GNHIES98, tetracyclines were the most frequently used antibiotics (21.7%), followed by beta-lactamase sensitive penicillins (14.5%) and macrolides (14.0%). In DEGS1, the most commonly used antibiotics were fluoroquinolones (21.9%), followed by macrolides (17.5%) and lincosamides (13.2%).

Conclusions: While overall use of antibiotics is low among community-dwelling adults in Germany, a significant reduction in antibiotics use has been observed from 1997 – 99 to 2008 – 11. Our study provides essential data and a baseline of antibacterial use among community-dwelling adults in Germany, which can be used for the assessment of efforts towards a more rational pharmacotherapy with antibiotics. Referenzen beim Verfasser.