Control of antibiotic use in the community: the Danish experience

The selection pressure for antibacterial resistance in the community might not be as high as in hospitals. However, it is generally accepted that it is in the primary healthcare sector that one can achieve the greatest decrease in the total use of antimicrobials. There are significant differences in the overall use of antimicrobials among European countries. On average, 80% to 90% of the total antibiotic use in each country takes place in the primary healthcare sector. Surveillance of the use of antimicrobials is the core for planning interventions and monitoring their effect. These interventions may be implemented for either political, economic, or professional reasons. Often, but not always, political interventions are governmental, and professional interventions are recommendations from professional associations. Examples of interventions at different levels in the Danish healthcare system, from the general practitioner to legislation by the government, will be presented together with their effect on the use of antimicrobials.