European Antibiotic Awareness Day will be marked next Sunday, and as has been the case every year, the Maltese health authorities seize the occasion to raise awareness about how to avoid their misuse, through billboards and posters as well as through the media.

Obviously, no medication should be misused, but the misuse of antibiotics is a particular concern since it does not only affect the patient taking them. Misuse can boost microbial resistance to antibiotics, making them less effective in cases where they are actually needed.

Each year, antimicrobial resistance is believed to result in 25,000 deaths and related costs of €1.5 billion in the EU alone.

At Mater Dei Hospital, Methicillin-resistant Staphylococcus aureus (MRSA) – a bacterium resistant to antibiotics, ends up present in 15% of patients, although the proportion has fallen by a third since the launch of a strategy in 2010. While most will not feel any effect or experience only minor problems, serious MRSA infections can be deadly and difficult to treat.

Regrettably, antibiotic misuse is far higher than it should be, although National Antibiotic Committee head Michael Borg did point out some encouraging figures, a sign that previous awareness campaigns have been leaving their mark.

While antibiotic use had been increasing year after year, this increase seems to have levelled off in the past couple of years, according to the NAC’s own statistics. The proportion of people taking antibiotics without prescription – contrary to all medical advice – had been as high as 19% ten years ago, but according to the European Commission’s Eurobarometer surveys, this went down to 4% - the EU average – by 2009.

“Our aim, obviously, is 0%,” Dr Cassar said, in reference to the latter statistic.

But the 2009 study also showed that antibiotic use in Malta was remarkably high. 55% of those surveyed admitted to taking antibiotics in the previous year, a rate second only to Italy’s 55% and significantly higher than the EU average of 40%. That, in itself, suggests that the Maltese are prone to overusing antibiotics.

One particular concern seems to be the use of antibiotics to treat viral infections, which they are completely ineffective against. Antibiotics are useless against the common cold or influenza, for instance, but that does not seem to stop patients from seeking them – or doctors from prescribing them. The Eurobarometer survey showed that the Maltese were significantly more likely than their European counterparts to believe that antibiotics killed viruses, and that they were effective against cold and flu.

Antibiotics can actually make one feel worse if used incorrectly: common side-effects of antibiotic use include diarrhoea.

Dr Cassar stressed that patients should not pressure pharmacists and doctors should the former refuse to hand out antibiotics without prescriptions or the latter refuse to prescribe them. He said that doctor-shopping or pharmacy-shopping – to find a more compliant doctor or pharmacist – was a mistake, adding that the ones who refused to provide antibiotics were likely to have been correct in doing so.

Evidently, some family doctors do prescribe antibiotics when they are not needed, and the NAC believes that awareness campaigns should also target them.

The NAC’s website, www.nacmalta.info, advises doctors to prescribe antibiotics only when necessary, according to evidence-based guidelines. They are also warned against prescribing wide-spectrum antibiotics – which are effective against a wide range of bacteria – when more specific medication is available: Dr Cassar noted that this was akin to using a machinegun where a pistol would have been sufficient.

Healthcare professionals are advised to explain to patients how they can relieve symptoms of colds and flu without the use of antibiotics, and on the importance of complying with the directions given when they are prescribed antibiotics.

Among other things, patients should not stop a treatment of antibiotics before it runs out simply because they no longer feel unwell. Improving health could be a sign that enough bacteria have been killed for one’s immune system to handle comfortably, but if the treatment is stopped abruptly, the bacteria that survive may build up drug resistance.

The relatively recent discovery of antibiotics has revolutionised health, transforming what had once been deadly infections into easily-treatable ones.

But the effectiveness of what had been a miracle cure is being dented by increasing drug resistance, and Dr Cassar stressed that everyone had to do their part to help ensure that antibiotics continue to be an effective remedy in the future.

Antibiotics

25,000 deaths/year attributable to antibiotic resistance in the EU

Malta has the second-highest rate of antibiotic use in EU

4% use antibiotics without prescriptions

MRSA detected in 15% of Mater Dei patients, although it is usually harmless