Did media attention of the 2009 A(H1N1) influenza epidemic increase outpatient antibiotic use in France?: A time-series analysis

Abstract

Background: In France, the 2009 A(H1N1) influenza epidemic occurred between September 2009 and January 2010. Sparking widespread controversy, it was intensely reported in the media. Despite therapeutic inefficacy, antibiotic consumption and viral respiratory infections are positively correlated, particularly in France, where antibiotic overconsumption is well-known. We first determined the period when media coverage was high, and then compared, during this period, observed outpatient antibiotic consumption to estimated outpatient antibiotic consumption "without media attention".

Materials and methods: TO EVALUATE MEDIA COVERAGE, TWO ONLINE DATABASES WERE CONSULTED: Factiva and Europresse. To quantify outpatient antibiotic consumption, we used data on reimbursements of outpatient systemic antibiotics from the computerized databases of the two main National Health Insurance agencies. Influenza-like syndromes data came from the French GPs Sentinelles Network. Weekly time-series of antibiotic consumption were modeled by autoregressive moving-average models with exogenous inputs and interventions. Analyses were computed for the entire series and by age group (0-5, 6-15, 16-60, and >60 years).

Results: Media coverage was intense between April 2009 and January 2010. No effect on total outpatient antibiotic consumption was observed during the whole mediatic period. However, during the epidemic in France (September 2009-January 2010), we found an antibiotic underconsumption for the entire series, 0-5 and >60 years. Additionally, at the beginning of the pandemic, when cases were still outside France (June 2009-August 2009), we found an antibiotic overconsumption for patients >16 years.

Conclusion: The early period of A(H1N1) virus circulation compared with seasonal influenza or an overdeclaration of ILS cases might explain the antibiotic underconsumption observed during the period of active A(H1N1) virus transmission in France. At the pandemic onset, when uncertainty was high, the overconsumption observed for individuals >16 years might have been caused by alarmist media reporting. Additional analyses are needed to understand the determinants of antibiotic consumption during this period.

Figure 1. Weekly number of antibiotic consumptions, periods and intervention functions used to construct the ARMAX model.

*Parameters estimated using the tendency since 2002 or the last observed one if it had changed. Dashed vertical lines separate the data periods and model predictions.

Figure 2. Weekly number of articles published on A(H1N1) and ILS incidence*: January 2009 – August 2010.

*influenza-like syndrome incidence per 100,000 inhabitants.

Figure 3. Weekly number of antibiotic prescriptions*: fit of the model and predictions for both scenarios^#.

*per 1,000 inhabitants. ^#Scenario 1 corresponds to the “stationary” hypothesis and scenario 2 to the “evolutionary” one.

Figure 4. Estimated and predicted changes for both scenarios^# of intervention functions for the entire series.

^# Scenario 1 corresponds to the “stationary” hypothesis and scenario 2 to the “evolutionary” one.