The role of microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals

This observational, cross-sectional study describes the role played by clinical microbiology and pharmacy departments in the stewardship of antibiotic prescribing in European hospitals. A total of 170 acute care hospitals from 32 European countries returned a questionnaire on antibiotic policies and practices implemented in 2001. Data on antibiotic use, expressed as De.ned Daily Doses per 100 occupied bed-days (DDD/100 BD) were provided by 139 hospitals from 30 countries. A total of 124 hospitals provided both datasets. 121 (71%) of Clinical Microbiology departments and 66 (41%) of Pharmacy departments provided out of hours clinical advice. 70 (41%) of microbiology/infectious disease specialists and 28 (16%) of pharmacists visited wards on a daily basis. The majority of laboratories provided monitoring of blood cultures more than once per day and summary data of antibiotic susceptibility testing (AST) for empiric prescribing (86% and 73% respectively). Most of the key laboratory and pharmacy-led initiatives examined did not vary signi.cantly by geographical location. Hospitals from the North and West of Europe were more likely to examine blood cultures more than once daily compared with other regions (p < 0.01). Hospitals in the North were least likely routinely to report susceptibility results for restricted antibiotics compared to those in the South-East and Central/Eastern Europe (p < 0.01). Hospital wards in the North were more likely to hold antibiotic stocks (100%) compared with hospitals in the South-East which were least likely (39%) (p < 0.001). Conversely, hospital pharmacies in the North were least likely to dispense antibiotics on an individual patient basis (16%) compared with hospital pharmacies from Southern Europe (60%) (p = 0.01). Hospitals that routinely reported susceptibility results for restricted antibiotics had signi.cantly lower median total antibiotic use in 2001 (p < 0.01). Hospitals that provided prescribing advice outside normal working hours had signi.cantly higher antibiotic use compared with institutions that did not provide this service (p = 0.01). A wide range of antibiotic stewardship measures was practised in the participating hospitals in 2001, although there remains great scope for expansion of those overseen by pharmacy departments. Most hospitals had active antibiotic stewardship programmes led by specialists in infection, although there is no evidence that these were associated with reduced antibiotic consumption. There was also no evidence that pharmacy services reduced the amount of antibiotics prescribed.The ARPAC study was funded by the European Commission (project QLK2-CT-2001-00915). F.M. MacKenzie was supported by the European Study Group on Antibiotic Policies to write this manuscript

A. Tovias, The European Communities\u27 Single Market: The Challenge of 1992 for Sub-Saharan Africa

Professor Tovias\u27 book is a refreshing and welcome addition to the existing literature on the different aspects of Europe 1992. The European Communities\u27 Single Market is divided into seven chapters. The introduction in Chapter One is preceded by a summary and conclusions. Chapter Two discusses the interdependence between the EC and Sub-Saharan Africa.\u27 The third and fourth chapters are devoted to the effects of eliminating specific intra-EC barriers and new barriers likely to arise from Europe 1992. Chapter Five comprises an analysis of the impact of Europe 1992 on various sectors, such as mineral products, tropical products, and services.\u27 In the sixth and final substantive chapter, the discussion focuses on the implications for Sub-Saharan Africa of Europe 1992\u27s export credit policies.\u27 The Book concludes with a set of policy recommendations, a detailed statistical annex, and a less comprehensive bibliography. \u27 On the whole, The European Communities\u27 Single Market is a well written and thought-provoking book. Its conclusions are clear and unequivocal. The Book could have benefitted, however, from a discussion of Europe 1992\u27s impact on the private sector of SSA. As explained below, the private sector in African economies is gradually but inevitably supplanting the public sector in importance. In fairness to Professor Tovias, however, it must be stressed that a book as brief as the one being reviewed cannot be expected to cover all aspects of Europe 1992\u27s likely impact on SSA

The Future of Free Trade in Europe and the World

This speech discusses the future of global free trade, and recommends more international efforts to bolster the multilateral system. The author looks to the European Union as playing a leading role in this effort, not only, as is sometimes claimed, because of its economic weight and its interest in free trade, but primarily because of its identity as an ordered community of nations, representing the very model of balance

Austerity and Human Rights Law: Towards a Rights-Based Approach to Austerity Policy, a Case Study of Greece

This Note analyzes the legal framework for the protection of the right to work under national and international laws, and the limitations for Greece regarding the implementation of austerity measures that result in causing retrogression in the enjoyment of this right. Part I discusses the background of the Greek financial crisis, the financial assistance mechanisms and the adopted austerity measures. Part II examines the legal framework for the protection of the right to work, as well as the principles of equality, non-discrimination and progressive realization of human rights under the International Covenant on Economic, Social and Cultural Rights (“ICESCR”). Finally, Part III demonstrates how the adopted Greek austerity measures violate international and national laws and advocates for the adoption of a stricter rights-based approach for states willing to implement austerity programs. Part III further argues for a rightsbased approach during times of financial crisis, with a minimum core of human rights obligations to always be respected