The European Centre for Disease Prevention and Control (ECDC) has marked 18 November 2008 as the first of the proposed annual European Union (EU) Antibiotic Awareness Days in an attempt to improve the use of antibiotics by families and professionals.

Antibiotics are the most common medicines given to children. In the UK, there are around 6 million antibiotic prescriptions for children each year, the majority given unnecessarily for viral upper respiratory tract infections.1 There is clear evidence linking antibiotic resistance to prescribing, with a possible threshold effect beyond which high prescribing can select resistant isolates.2 Factors such as duration of treatment, dose and class of selected antibiotic3 are important in the resistance chain, along with host susceptibility and pathogen transmissibility.4 Children are an excellent environment for the selection of resistant bacterial pathogens after recent antibiotic use, particularly in day care. As recent studies have suggested, the individual child can host resistant pathogens after antibiotic use for up to 3 months, which is sufficient to sustain a high level of antibiotic resistance in the general population.5 If the amount of antibiotics prescribed in children could be reduced, selection and transmission of resistant strains should occur less often, with an effect on the general population. Is Europe responding to this challenge?

Surveillance of antimicrobial consumption in European children is currently surprisingly poor and not systematic. European organisations such as ESAC (European Surveillance of Antimicrobial Consumption) and EARSS (European Antimicrobial Resistance Surveillance System) collect some excellent data on antibiotic consumption and resistance in the adult population of Europe, but provide very limited paediatric country-specific and age-specific data. In adults, there is very significant variation in antibiotic use across Europe. In a study recently published by ESAC, total outpatient antibiotic use in 2003 varied by a factor of 3 …