European Surveillance of Antimicrobial Consumption (ESAC): outpatient macrolide, lincosamide and streptogramin (MLS) use in

Background: Data on outpatient cephalosporin use in Europe were collected from 25 countries within the ESACproject, fundedbyDGSANCOof theEuropeanCommission, using theWHOATC/DDDmethodology. Methods: For the period 1997–2003, data on outpatient use of systemic cephalosporins aggregated at the levelof theactivesubstancewerecollectedandexpressed inDDD(WHO,version2004)per1000 inhabitants per day (DID). Use was analysed in detail, using the new ATC codes J01DB, J01DC, J01DD and J01DE, introduced in the 2005 issue of the WHO ATC index and assigned to the four cephalosporin generations. Results: Total outpatient cephalosporin use in 2003 varied by a factor of 270 between the country with the highest (6.18 DID in Greece) and lowest (0.02 DID in Denmark) use. First-, second- and third-generation cephalosporins were usedmost in 6, 16 and 3 countries, respectively. We observed fourth-generation use (mainly cefepime) in ambulatory care in 11 countries. From 1997 to 2003 cephalosporin use decreased in 13 countries, in Francebymore than 1DID.A relative increaseof second-generation (mainly cefuroxime) or third-generation use (mainly cefpodoxime or cefixime) bymore than 10 % in 12 countries coincidedwith an equally largedecreaseof first-generationuse in eight countries (mainly cefadroxil, cefalexinor cefatrizine). In six countries, first-generation use increased, second-generation use decreased or both occurred. Conclusion: The new ATC codes allow a more detailed description of outpatient cephalosporin use. Th