French Reforms Hit Antibiotic Sales

The impact of France's health reform on sales of antibiotics was substantial in first-half 1994. This market has been growing about 10% annually, but during the first six months of the year the system of medical references, introduced to reduce reimbursement costs, generated a 15% downturn.

Antibiotics represent 10% of French drug consumption, and their drop was the sharpest of any therapeutic category. The fall-off was partly due to a lack of major epidemics in January and February, but mainly due to the references, which are presented as advice to prescribers and tend to oppose use of strong antibiotics. Second-generation cephalosporins or systemic fluoroquinolones, for example, are not recommended as the first line of attack in patients "without particular risk factors." For acute infections, the references urge doctors to use classic and cheapest drugs first, such as penicillin. Doctors are free to ignore the advice, but in practice, says an industry source, "they are thinking twice before prescribing, especially antibiotics."

The impact of the references, it is suggested, triggered the 24% fall in oral cephalosporin sales in first-half 1994, and sales of Roussel-Uclaf's third-generation product dropped 40%. SmithKline Beecham's Augmentin (amoxycillin/clavulanic acid), which reached 750 million French francs ($141.7 million) in 1993, fell 20%. The system does not affect drugs such as Bayer's Ciflox (ciprofloxacin) or macrolides as such, but even their sales are down, while the cheapest have resisted.