Consumption of antibiotics in Greenland, 1964-1970. I. Economic and epidemiological considerations.

Recognition of the public health and financial problems involved in the increasing use of pharmaceutical products is of major importance to-day (WHO, 1971). A deeper knowledge of the extent and development of drug consumption is necessary to evaluate the significance of these problems. It is possible to obtain such knowledge in relatively few countries (Engel and Siderius, 1968; NMD, 1972). The various national data assembled for presentation at the WHO Symposium on Drugs in 1969 were not generally comparable, since the mode of registration, the socio-economic factors, and the organization of the local health services varied so widely (WHO, 1970). One particular aspect of treatment with antibiotics is the coincidental effect on recognized and unrecognized infections, including that on the resistance pattern in hospital infections (Barber, Dutton, Beard, Elmes, and Williams, 1960; Ridley, Lynn, Barrie, and Stead, 1970; Biilow, 1971) and in gonorrhoea (Willcox, 1970; Olsen, 1973a,b). There is also the question of the effect on the incidence of syphilis arising from the action of these drugs on unrecognized treponemal infections (Olsen, 1973c). An assessment of the consumption of drugs in Greenland proved to be relevant to the investigation of the changes which have taken place in the sensitivity of gonococci to antibiotics (Olsen, 1973b) and to the occurrence in Greenland of cases of syphilis modified by the use of antibiotics (J0rgensen, personal communication; Knudsen, personal communication). The supply of drugs to Greenland is centralized, and it has thus been possible to obtain detailed information concerning the annual importation of antibiotic preparations. The aim of the present work was to relate the consumption of drugs in Greenland to the morbidity of bacterial infections and to determine the costs involved. The analysis of the findings was also used to investigate the coincidental effects of drug usage on syphilitic (Olsen, 1973c) and gonococcal infections (Olsen, 1973a, b).