One reason for the higher prevalence of resistance in the United States may be the higher levels of antibiotic prescribing in this country (see Box 2.5, Chapter 2). Although antibiotic prescribing has fallen in the United States since 1994, it remains among the highest in the world (Steinman, Gonzales et al. 2003). Data from the European Surveillance of Antibiotic Consumption (Goossens, Ferech et al. 2003) show prescribing rates for most countries from 1997 to 2002 (Figure 1.6). The prescribing rate in the United States was 24 defined daily doses per 1,000 population per year. Only five countries France, Luxembourg, Italy, Greece, and Portugal had higher rates, but some of these countries had lower rates of resistance than the United States, indicating that there may be other casual factors.