Overuse of antibiotics could mean a huge set back for medicine

Alexander Fleming's discovery of penicillin in 1928 marked a revolution in the world of medicine. Once fatal illnesses became easily curable and the mortality rate dropped the world over. Today doctors depend on antibiotics to treat a wide range of bacteria-related illnesses from the common ear-infection to meningitis. But gradually the effectiveness of antibiotics has begun to wane and there have been cases of patients dying because even the strongest available antibiotics failed to work.

This unhappy state of affairs is the result of widespread overuse of antibiotics both in human medicine and agriculture. Dr. Vlastimil Jindrak who heads the national programme for antibiotics says that overuse of antibiotics varies from country to country but that we all bear some responsibility:

"Unfortunately this is true of countries around the world, including Europe. But there are huge differences- the situation in southern Europe is much worse than for instance in Scandinavia. There are various studies monitoring antibiotics use and the reasons for overuse. One such study compares the situation in France and Germany and one of the findings is that GPs in France prescribe antibiotics to 50 percent of patients who come to them with a mere cold. In Germany only seven percent of cold sufferers get a prescription for antibiotics from their doctor. This is very interesting because doctors in both countries know that a cold is a viral disease where antibiotics are of no use at all."

Studies indicate that 40 to 50 percent of the antibiotics prescribed by Czech GPs are unnecessary. But why would doctors want to prescribe antibiotics for a viral disease when they know better than anyone that ultimately they could lose a very important weapon against bacterial infections? Dr. Jindrak says there are many reasons for this behavior. Some patients actually demand antibiotics and feel cheated if their GP just prescribes rest, hot tea and a higher intake of vitamin C.

"Sometimes parents want the doctor to prescribe antibiotics for their children and it is not always easy for doctors to explain to them that antibiotics are really not necessary. Sometimes doctors are worried about losing patients if they don't agree to prescribe antibiotics for them because it is very easy for the parents to take their child to another physician."

When I have spoken to doctors they also say they are under pressure from pharmaceutical companies...

"Yes, yes, I absolutely agree with you that the pressure of pharmaceutical companies is really very strong and very specific in the conditions of the Czech Republic. Especially in the 90s it was a very new situation for us -as doctors - to communicate with representatives of the pharmaceutical industry."

In many cases antibiotics are used as a preventive measure, because a viral infection may easily develop into a bacterial one. Dr. Jindrak says that many pediatricians use antibiotics as prevention and in hospitals - especially in intensive care units- this is a common practice.

"That seems to be a sort of pre-emptive tactic. When a child has a viral disease and is febrile doctors often decide to prescribe antibiotics in order to avoid the danger of a bacterial infection developing. But that is not very rational. At such a point I would say that antibiotics actually present a greater risk of bacterial infection because the protective barrier of normal flora in the larynx and upper respiratory tract is inevitably destroyed by the antibiotics. So it is not at all easy to use antibiotics as prevention. Another matter is how we use antibiotics in hospitals. There the situation is very different because you are dealing with seriously ill people - especially in ICUs - and in these conditions we need very strong and effective antibiotics for treatment of serious infections. And we also need them to prevent complications from which the patient could die."

However it is not just the antibiotics your doctor prescribes which contribute to the damage being done. One should not underestimate the role of antibiotics we get from the food chain.

"I would say that approximately 50 percent of all antibiotics used are antibiotics used in veterinary medicine and agriculture. That has a far-reaching impact because there are transfers of pathogens of bacteria - and their newly acquired resistance - from animals to humans. So it is very important to coordinate activities aimed at preventing anti-microbial resistance between veterinary medicine and human medicine. In the past antibiotics were commonly used as growth stimulators. Fortunately that has now been prohibited for several years and that is a very important step in the effort to limit the use of antibiotics in the veterinary field. That I would say is important progress, especially in Europe."

The widespread overuse of antibiotics has resulted in a sharp rise in antimicrobial resistance. Illnesses once thought to be easily curable are becoming harder to treat and could potentially become life-threatening once again. Is there still time to reverse this process? Specialists say that a coordinated worldwide effort could achieve results. There is now a network of antibiotics centers across the Czech Republic which cooperates closely with GPs and specialists, monitoring prescriptions and giving doctors important feedback on the effects of overuse. Dr. Jindrak says countries such as Sweden and Holland are setting an excellent example:

"I have first hand experience from the Netherlands and Sweden and I must say that their system of prevention is very sophisticated. They are doing a lot against overuse of antibiotics and they are really very successful. The resistance rates among patients are very low and the total amount of antibiotics used in much lower in comparison with say southern Europe."

So what can countries like the Czech Republic do to alleviate the damage? Dr. Jindrak says that a comprehensive programme with good interdisciplinary cooperation between doctors and specialists combined with government support should stand a good chance of success. On the other hand, continuing along the road of over-use would lead to disaster. Ailments such as an ear infection or pneumonia would become life-threatening and modern day medicine -as we know it -would collapse.

"It is important to know that many medical programmes - transplantation, oncology, surgical disciplines - really depend on antibiotics. Doctors need very strong antibiotics for treatment and also for prophilaxis. For instance in bone marrow transplants it is impossible to perform without antibiotics. So there are also these risks - limited possibilities for providing this kind of care."