Another limitation of the study is the fact that we considered antibiotics dispensed in the previous 4 years. Prescription of antibiotics based on reimbursement data can mimic antibiotic consumption in most European countries, but is not true in southern European countries. A landmark paper published in 2007 with the use of sales data in 2002–2005 showed a difference between prescription and consumption of up to 30% in Spain, mainly due to the over-the-counter sale of antibiotics without a medical prescription and antibiotics prescribed by the private sector [19]. A higher antibiotic consumption would very likely have been associated with greater resistance rates to antibiotics.