Antibiotic policies in Central/Eastern Europe (CEE) after 1990.

Significant political and social changes in Eastern Europe have caused dramatic changes in healthcare: Centralized state drug policies were decentralized, vaccination strategies in some countries changed and directed financing of healthcare replaced by one or multiple health management organisations (HMO). Centralized Infectious Diseases and/or Antibiotic Resistance surveillance were stopped after 1990 in four of six countries but resurrected after 1996 in Hungary, Poland and Slovakia. According to antibiotic (ATB) resistance and nosocomial infection rates, there are some differences in comparison to Western and Northern Europe e.g., a higher incidence of penicillin resistant pneumococci, ampicillin resistant H. influenzae and methicillin resistant Staphylococcus aureus. Because of increasing consumption of ATB before 1991, due to the free market, pharmaceutical marketing and reimbursement policies, several strategies to decrease consumption and/or resistance were implemented such as restriction of outpatient use, national and hospital formularies and Health Management Organizations-based restrictions. Probably due to the short time scale, no significant reduction in resistance has been documented although antibiotic consumption has declined.