Health: why antibiotic consumption in France has returned to pre-Covid levels

Europe 1 with AFP / Photo credits: Thibaut Durand / Hans Lucas / Hans Lucas via AFP 16:00 p.m., November 13, 2023

"Antibiotics are not automatic"... The slogan flourished and yet, consumption in France, which had fallen at the beginning of Covid, rose in 2022 for the second year and more strongly, especially among children. "If antibiotic consumption remains generally downward since 2012, it has increased in 2022 at a faster pace than in 2021," according to an annual study by Public Health France (SPF) based on prescription reimbursements by health insurance, published in the run-up to World Antibiotic Awareness Week (November 18).

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"A rise in consumption over the past two years"

The increase is obvious, both in terms of prescriptions and doses consumed in cities (excluding hospitals): +16.6% over one year in the first case (with more than 800 antibiotic prescriptions per 1,000 inhabitants in the year), and +14% in the second case (with 21.6 doses per 1,000 inhabitants per day). While "the Covid pandemic had shown a break in the curve", Laëtitia Gambotti, head of the healthcare-associated infections and antibiotic resistance unit of Public Health France, noted to AFP "a rise for two years in consumption, back to 2019 levels".

"We had a small hope that the decline observed in 2020 could be sustained, or at least that we would keep an achievement, but, as in other European countries, this was not the case," commented Dr. Anne Berger-Carbonne, another specialist at the health agency.

A "significant" rise in the 0-14 age group

The year 2020 remains unique: strict anti-Covid measures (lockdowns, barrier gestures) had reduced the frequency of bacterial infections but also access to care. "2021 and 2022 were accompanied by a resurgence of common winter infections, medical consultations and antibiotic prescriptions, particularly in their last quarters," SpF pointed out.

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However, this recovery "remains at a slightly lower level than that observed in 2019", before the Covid pandemic, the agency said. "Important" in children, the consumption of antibiotics among these young patients has returned in 2022, or even exceeded, the pre-pandemic level. "The increase is greater among 0-14 year olds, populations more prone to winter epidemics," said Laëtitia Gambotti.

One of the five worst performers in Europe

However, the 2022-2023 season was marked by a triple epidemic of influenza-bronchiolitis-Covid, but also other pathologies - although partly viral - which influenced the consumption of antibiotics, especially at the end of the year. The flu fuelled an "unusually long and early" epidemic, bronchiolitis reached a "very significantly higher amplitude than in previous years", acute gastroenteritis returned to levels comparable to those before the pandemic, SpF observed.

In addition to age groups, antibiotic use varies by region, where disparities have been broadly stable over the past decade. Corsica and Provence-Alpes-Côte d'Azur appear to be the most user-intensive, while Pays de la Loire and the overseas departments are the least consuming. But, overall, "France remains one of the top five European countries with the highest consumption of antibiotics," Gambotti noted.

Excessive or inappropriate use of these treatments

This specificity is linked to practices and a history of the drug approach that are different from other countries, but also to a cultural dimension of antibiotic prescription. Antibiotic resistance, which has worried global health authorities for years about its deadly consequences, is exacerbated by excessive or inappropriate use of these treatments.

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The decline in antibiotic consumption is an objective of health authorities, in France and in other countries, to curb the appearance of resistant bacteria. "Otherwise, the risk, in the long term, is that we will no longer have the therapeutic arsenal for certain bacterial diseases, which can cause mortality, especially among the most vulnerable," said Laëtitia Gambotti.

To raise awareness again, SPF will rebroadcast, from December, a campaign on the proper use of antibiotics ("taking good care of yourself is first of all using them well"), effective only against bacterial infections, of no interest against viral infections such as bronchiolitis or influenza. For Anne Berger-Carbonne, "we have to wait until 2023 to see where we are in the efforts to reduce antibiotic consumption".