18 Pascoe SJS, Langhaug LF, Mavhu W, et al. Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women. PLoS One 2015;10:e0115290. 19 Okeke CE, Onwasigwe CN, Ibegbu MD. The effect of age on knowledge of HIV/ AIDS and risk related behaviours among army personnel. Afr Health Sci 2012;12: 291–6. 20 Wyman MF, Shiovitz-Ezra S, Bengel J. Ageism in the Health Care System: Providers, Patients, and Systems. Contemporary Perspectives on Ageism. Cham:Springer, 2018: 193–212. 21 Roundtable on Population Health Improvement; Board on Population Health and Public Health Practice; Institute of Medicine. Exploring Opportunities for Collaboration Between Health and Education to Improve Population Health: Workshop Summary. 2, Why Educational Attainment is Crucial to Improving Population Health. Washington (DC): National Academies Press (US), 2015. Available at: https://www.ncbi.nlm.nih.gov/books/NBK316096/ (March 2021, date last accessed). 22 World Health Organization. Implementation of Option Bþ for Prevention of Mother-to-Child Transmission of HIV: The Malawi Experience. Available at: https://apps.who.int/iris/bitstream/handle/10665/112849/9789290232520.pdf. (March 2021, date last accessed). 23 Jung M, Arya M, Viswanath K. Effect of media use on HIV/AIDS-related knowledge and condom use in Sub-Saharan Africa: a cross-sectional study. PLoS One 2013;8: e68359. 24 Levy H, Janke A. Health literacy and access to care. J Health Commun 2016; 21(Suppl 10):43–50. ................................................................................................................................................................... The European Journal of Public Health, Vol. 31, No. 6, 1137–1143 ß The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckab143 Advance Access published on 17 September 2021 ......................................................................................................... Trend of antibiotic consumption and its association with influenza-like illnesses in France between 2004 and 2018 Sally Yaacoub 1 , Emilie Lanoy 2,3 , Karima Hider-Mlynarz 4 , Nadine Saleh 5,6,7 , Patrick Maison 1,4,8 1 EA 7379 EpiDermE Group, Paris-Est Creteil University, Creteil, France 2 Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France 3 Biostatistics and Epidemiology Unit, Paris-Saclay University, Paris-Sud Univ., UVSQ, CESP, INSERM, Villejuif, France 4 ANSM, Saint Denis, France 5 Faculty of Public Health, Lebanese University, Fanar, Lebanon 6 INSPECT-LB: Institut National de Sante ´ Publique, Epide ´ miologie Clinique et Toxicologie, Beirut, Lebanon 7 Faculty of Public Health, CERIPH (Center for Research in Public Health), Lebanese University, Fanar, Lebanon 8 CHI Creteil, Creteil, France Correspondence: Prof. Patrick Maison, ANSM, Saint Denis, France, Tel: þ0033 155 87 35 23, e-mail: patrick.maison@ansm.sante.fr Background: Antibiotic consumption has been reported to be driven by the treatment of respiratory tract infections. Our objectives were to describe the trend of antibiotic consumption in France compared with that of other European countries; to describe the evolution of each antibiotic class in France; and to explore the relationship between antibiotic consumption and incidence of influenza-like illnesses. Methods: In this observational study, antibiotic consumption was reported as defined daily doses per 1000 inhabitants per day in the community and hospital sectors in descriptive and graphical formats, using data from the European Surveillance of Antimicrobial Consumption Network database. The total consumption and the consumption of different classes of antibiotics in France according to time and influenza-like illnesses were studied using multiple linear regression models. Results: The total consumption of antibiotics in France was constant over the 15 years. It was driven by the community sector (92.8%) and was higher than the consumption of other European Union countries (P-value < 0.001). The beta-lactam penicillins were the most consumed antibiotic class and the only class that increased with time. The multiple linear regression models showed a positive correlation between antibiotic consumption in the community sector and incidence of influenza-like illnesses [B ¼ 0.170, 95% CI (0.088–0.252)]. Similar significant results were shown between other antibiotic classes used in the management of influenza-like illnesses (other beta-lactams, and macro- lides, lincosamides and streptogramins) and influenza-like illnesses. Conclusion: Our results suggest that antibiotics used in the management of respiratory tract infections might be involved in the irrational use of antibiotics. ......................................................................................................... Introduction A ntibiotic resistance, a global public health concern, is rising to alarming levels worldwide. 1 According to the World Health Organization (WHO), antibiotic resistance has a financial and health toll. It increases the medical costs, prolongs hospital stays and increases mortality. Although the development of antibiotic resistance is a normal evolutionary process, the wide-spread use of antibiotics fast-tracks it. 1 The major infections implicated in the high antibiotic consump- tion are common infections such as acute bronchitis, acute rhino- sinusitis, pharyngitis and influenza. 2 In most of the cases, these respiratory tract infections (RTIs) are viral in etiology and do not require antibiotics. However, according to the Centers for Disease Control and Prevention, 70% of the antibiotics prescribed in adults for acute RTIs are unnecessary. 3 In fact, upper RTIs (URTIs) accounted for 57% of antibiotics consumed in Europe, whereas, lower RTIs accounted for 30%. 4 Influenza and influenza-like Trend of antibiotic consumption in France over a 15-year period 1137 Downloaded from https://academic.oup.com/eurpub/article/31/6/1137/6371856 by guest on 11 June 2022