Inventory of antibiotic stewardship programs in general practice in France and abroad

Abstract

Objectives: The authors conducted a survey of measures implemented in France and abroad for a better use of antibiotics in general practice.

Methods: A literature review was conducted from January 2000 to July 2014. Emails were sent to every infectious diseases department, to all regional health authorities (ARS), to the health insurance offices (CPAM) with the highest and lowest antibiotic use, and to the ministry of health to make an inventory of all antibiotic stewardship programs. The ministry of health, the board of general practitioners, infectious diseases specialists, pharmacists, and the medical and pharmacy schools of the nation's capital were contacted in 17 countries of Europe and North America.

Results: The main measures implemented in France were training of healthcare professionals, publishing guidelines, feedback to the practitioners on their prescriptions, and availability of rapid diagnostic tests. Telephone networks were created in some regions, such as Antibiolor or Medqual, to help physicians with antibiotic prescription. Many foreign countries issued pedagogical material to physicians, for patients to explain what to do in case of viral infection or delayed prescription. In Alberta (Canada), the government introduced an optional authorization for quinolones. In Denmark, the government temporarily suspended the reimbursement of some agents to preserve them according to bacterial ecology. In the United-Kingdom, the antibiotic susceptibility test report must include less than 5 agents.

Conclusions: The measures implemented in France and abroad were usually more persuasive than restrictive. But the bacterial resistance crisis should lead to implementing more restrictive measures.

Keywords: Antibiotics; Antibiotiques; Bon usage; General practice; Misuse; Médecine générale; Mésusage; Stewardship.