TY - JOUR T1 - Antibiotics in acute exacerbations of COPD: the good, the bad and the ugly JF - European Respiratory Journal JO - Eur Respir J SP - 1 LP - 3 DO - 10.1183/09031936.00211911 VL - 40 IS - 1 AU - Wim G. Boersma Y1 - 2012/07/01 UR - http://erj.ersjournals.com/content/40/1/1.abstract N2 - You may well wonder what the connection might be between the title of this editorial and the famous Western The Good, the Bad and the Ugly. Well, we know that antibiotics are effective in treating bacterial infections (the good), are not as harmless as both clinicians and patients may think (the bad), and may have adverse effects and do not work in viral infections (the ugly). There is an increasing awareness that we have to challenge the problems caused by the overuse of antibiotics. Beliefs, expectations and incentives are the drivers of antibiotic overuse among the concerned parties: patients, physicians and society. Therefore, social norms would have to be altered, resulting in a fundamental change in patients' expectations, marketing, indications for antibiotic use and, particularly, physicians’ prescription behaviour. In a recent paper by the McDonnell Norms Group [1], some radical solutions were suggested, ranging from “changes in the way physicians are paid for prescribing antibiotics” and “looking at accuracy and limitation of antibiotic use” to “patients might be reimbursed differently for antibiotic prescriptions”.Antibiotic resistance is inevitably related to excessive antibiotic use. The frequency of antibiotic resistance in bacteria among different countries is proportional to their relative rate of antibiotic use [2]. This is generally expressed in defined daily doses per 1,000 inhabitants per day (DID). Countries in southern and eastern Europe have the highest DID, whereas consumption is much lower in northern Europe [1, 3]. Antibiotic consumption differs among various countries in Europe. In 2008, the proportion of outpatient penicillin use ranged from 30.1% in Germany to 62.6% in Denmark, whereas the proportional use of quinolones ranged from 3.1% in the UK to 17.0% in Russian. Efforts to control overprescribing of antibiotic use can be successful, as has been shown in … ER -