[Use of antimicrobial agents in Norway 1980-92]

Use of systemic antimicrobial agents in Norway shows a moderate increase from 1980 to 1992, from 13.5 to 16.9 defined daily doses (DDDs) per 1,000 inhabitants per day. Comparing the Nordic countries, the use of these drugs is second lowest in Norway, after Denmark. In relative terms the use of tetracyclines is highest in Norway. Use of co-trimoxazole is also relatively high, while use of macrolides is low. The share of penicillin V and G is highest in Sweden. Several new and important antimicrobial agents have been introduced on the Norwegian market during the period, while almost as many have been withdrawn. Penicillin V and G constitutes the main subgroup. However, the use of tetracyclines is almost as high, for a short period in fact higher. Taking into account the development of drug resistance and adverse events, it is recommended that use of tetracyclines and co-trimoxazole be reduced, mainly to the advantage of penicillins. The use of cephalosporins seems to be reasonable, but penicillins should be considered more often as an alternative. The use of antimycotic and antiviral drugs is low in terms of DDDs. In 1992 the cost of antimicrobial agents for systemic use was in 1992 approx. NOK 400 million, retail price. The largest subgroup, cephalosporins, constituted almost 20%, as against only 2% of DDDs. Antimicrobial agents represent a substantial part of the total drug budget in hospitals. A shift from expensive to cheaper alternatives should be considered as a routine. Moreover, an optimal change from parenteral to oral administration could help to reduce costs.