48% of the Maltese participants in a 2016 Eurobarometer survey reported being prescribed at least one antibiotic during 2015 – the vast majority saying that it had been prescribed the medicinal for a cold, flu or sore throat - conditions for which antibiotics are not normally indicated.

A strategy and action plan for prevention and containment of antimicrobial resistance in Malta for the years 2018-2025 was launched today by the Health Ministry, and Superintendent of Health Dr Charmaine Gauci shared the main points of the plan in a meeting with media outlets. Also presenting the plan were Chairperson for the Antibiotic Committee Professor Michael Borg, and Veterinary Regulation Directorate Director Dr Roberto Balbo.

Antimicrobial resistance (AMR) refers to the ability of microorganisms to resist the action of antimicrobials, which occurs when microorganisms become resistant to medication such as antibiotics, making infections or diseases more difficult or impossible to treat.

Antibiotics are very important to the medical sector as they are given to patients to treat or prevent infectious diseases that could otherwise lead to death. This creates a delicate balance whereby one must practice strict discipline when prescribing or taking such antibiotics as over-use could create problems in the future with regards to AMR.

According to a 2015 Eurobarometer survey only 27% of Maltese individuals knew that antibiotics do not eradicate viruses, and 39% knew of their ineffectiveness against colds and flu. This shows that there is a lack of education in terms of people understanding the proper uses and applications of this kind of medicine in our everyday life.

Initiatives such as this have been successful in past, particularly with regards to incidences of healthcare associated MRSA in Mater Dei Hospital which have been reduced by more than 70% following the start of the AMR Strategy in 2010.

Unfortunately Malta still sees between 25 and 35 deaths due to their bodies learning to resist certain types of antibiotics. Which although a long shot from the 650,000 infected and 30,000 dead worldwide, still remains an issue when taking it in proportion to Malta’s tiny population.

This issue is not restricted to humans as animal health also plays a part in the equation of AMR.

In Malta the National Veterinary Laboratory tests a very limited set of isolates every year, the bare minimum to be in compliance with EU requirements. In spite of this very limited information, AMR in animals is still a significant problem – with almost 50% of Salmonella poultry tested in 2014 being found to be resistant to ciprofloxacin, and 86% of E. coli strains from the same source found to be resistant to the same antibiotic.

 

Aim and objectives

The strategy aims to lengthen the time antibiotics may be used in the long term, without them being rendered unusable due to the aforementioned overprescribing, which would lead to improved human and animal health.

It also outlines seven main objectives that are to be focused on:

·         The necessary legislation and infrastructure to address AMR and implement effective strategies must be ensured by updating the current framework. Particularly developing regulations, strengthening enforcement and monitoring for a One Health Approach, which includes updating legislation in areas that are affected by this issue.

·         Effective antimicrobial stewardship practices across human health and animal health must also be implemented to ensure the appropriate prescribing, dispensing, administering and disposal of antimicrobials.

·         Strengthening the relevant surveillance and feedback systems on antibiotic use and resistance in human and animal health as well as the environment, which is particularly important to understand how resistant organisms and antimicrobial usage is impacting the country. This also helps to identify emerging resistances and trends.

·         The improving of infection prevention and control measure to help prevent infections and the spread of antimicrobial resistance.

·         Increasing the awareness and understanding of AMR, its implications and actions to combat it through education and training by educating stakeholders involved in combatting AMR.

·         Intensifying the research agenda through consensus, coordination and collaboration on initiatives that increase the knowledge and evidence base of AMR.

·         And the final objective is the tightening of international partnerships and collaboration on regional, European and global efforts to respond to antimicrobial resistance. This is emphasized due to the increasing movement of people, animals, foods and other products that may facilitate the movement of resistant pathogens across borders.