CHANGES IN THE USE OF ANTIBACTERIAL DRUGS IN THE COUNTRIES OF CENTRALAND EASTERN-EUROPE

Use of systemic antibacterial drugs in the countries of central and ea stern Europe (CCEE) has been studied using the defined daily doses (DD D) methodology. For the comparison, national wholesale data from Bulga ria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Sloven ia and Romania for the years 1989 and 1992 were used, i.e. for the yea rs before and after the rapid sociopolitical changes in these countrie s. Substantial differences in the patterns of antibacterial drug use b etween countries as geographically and economically similar as the CCE E were observed. The general sales of antibiotics varied almost twofol d among the CCEE and had decreased in most of the CCEE during the stud y period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum pen icillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spec trum penicillins varied within the range of 4% in Bulgaria to 38% in S lovakia, and had decreased during the study rears in all countries. Am inoglycosides accounted for 5-12% of all antibacterials in Bulgaria, E stonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumptio n of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ran ked among the top ten drugs in all countries studied. All countries ha d their specific preferences in the top ten lists; but the rationality of these traditions can be questioned: tetracycline + oleandomycin in Bulgaria; penamecillin in the Czech Republic and Hungary; sulphonamid es in Estonia and Lithuania; and benzathine penicillin and streptomyci n in Slovakia. The international differences in antibiotic utilization are suggested to be related to the respective health care systems (e. g. drug reimbursement) and prescribing preferences (e.g. therapeutic t raditions), quite apart from possible differences in drug efficacy, dr ug tolerance and the prevalence and severity of various infections.