The Global Irrational Use Of “Antibiotics” And Its Causes

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What are Antibiotics?

Antibiotics are drugs that aid in preventing diseases brought on by bacteria. They accomplish this by eliminating the germs or by preventing them from duplicating or procreating.

Antibiotic means “against life.” A medicine is technically considered an antibiotic if it kills bacteria inside the body. However, the majority of the time the term is used about antibiotics. In the 1920s, when the first antibiotics were developed, strep throat was one of the common mild bacterial illnesses that caused fatalities. surgery was even riskier. However, after the discovery of antibiotics in the 1940s, individuals were able to survive previously fatal diseases, live longer, and have safer procedures.

What is the “irrational use of antibiotics”?

Irrational antibiotic use includes self-medication, giving inappropriate dosages, and treating conditions that are not bacterial. Resistance to routinely available antibiotics has been quickly rising as a direct result of irrational antibiotic use. This tendency is linked to worse health outcomes, extended hospital stays, higher patient and governmental costs, and higher mortality.

Current Global and European Scenario of Antibiotic Use and Resistance

One of the most affordable, life-saving medications that also increase lifespan is the antibiotic. The rapid rise in antibiotic resistance (ABR), along with the dearth of new antibiotics (or antibiotic combinations) with novel modes of action, is seen to pose a danger to world health. This compromises the effectiveness of antibiotics. The World Health Organization (WHO) defines rational medicine use as giving patients the right medications for the right conditions, at doses that are right for them, for the right amount of time, at the right cost for both them and society and with the right information. When one or more of these criteria are not met, irrational or needless medication use occurs.

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Although hospitals only utilize 10–20 percent of all antibiotics, they use them at a much higher rate than the general population. Hospitals are important settings for the use of antibiotics used as a last resort, like carbapenems and polymyxins. For instance, ESAC-Net data revealed that hospitals used more cephalosporins, other beta-lactams (including carbapenems), and other categories of antibiotics than the general public. Consumption of carbapenem is significantly correlated with the percentage of invasive Klebsiella pneumonia that is carbapenem-resistant. Therefore, it is extremely concerning that more than a million prescriptions for carbapenem are written in Europe each year, according to data.

The effects of ABR are detrimental to both health and the economy. Drug-resistant diseases cause about 700,000 deaths worldwide each year. If nothing is done, this is anticipated to rise to 10 million by 2050, with associated expenses reaching the US $100 trillion globally. Only in the European Union (EU),  25,000 patients per year pass away from diseases brought on by multiresistant bacteria, at a societal cost of about €1.5 billion each year. Expected annual losses from multiresistant will amount to 2.9 trillion USD by 2050.

Antibiotics
Antibiotics

Factors that Lead to Irrational Antibiotic Use

1) Insufficient General Education and Awareness

Strong predictors of irrational antibiotic usage include public knowledge, attitudes, and beliefs about antibiotics. According to the most recent Eurobarometer survey, 34% of Europeans used antibiotics at least once in 2016. There is a need to educate European populations about antibiotic use and resistance. For instance, 44 percent of people are ignorant that antibiotics are useless against cold and flu viruses, and 57 percent are unaware that antibiotics are useless against viruses. Antibiotic use is higher in persons with lower education levels (39 percent versus 32-33 percent) and in less fortunate economic situations (44 percent compared with 31 percent ).

2) Antibiotics availability without a prescription

Due to a potential lack of access to appropriate diagnostics and diagnostic tools, the availability of antibiotics without a prescription is a driving factor for irrational antibiotic usage. ABR ultimately develops and spreads as a result of this. Ninety-three percent of Europeans said they got their antibiotics from a doctor on prescription or directly. Nevertheless, 4% of Europeans reported getting their last course of antibiotics without a prescription, despite the legal framework mandating that antibiotics should only be prescribed by a doctor and that over-the-counter (OTC) sales of antibiotics are prohibited in all Member States of the European Union (there are some exceptions in some of them—for instance, creams or eye drops that contain antibiotics).

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According to a European survey, the use of antibiotics without a prescription, obtained over the internet or purchased in another nation, is thought to be a developing problem. There are a large number of unlawfully functioning foreign internet pharmacies outside the EU that can ship medications to European patients by mail or courier. These internet merchants, who sell antibiotics without a prescription, are neither permitted to conduct business in the EU nor follow national regulations and standards.

3) Unused antibiotics

The practice of self-medication is made easier by leftover (remaining) antibiotics from prior prescriptions when the patient did not follow the therapy or the number of antibiotics prescribed surpassed the treatment length. The formation of resistant strains is favored by extended or repeated antibiotic use, which exerts a larger selective pressure on the normal bacterial flora than a single course of treatment.

4) Healthcare professionals’ information, orientation, and perceptions of antibiotics use and resistance

Antibiotic usage decisions and antibiotic type selection ultimately fall under the purview of prescribers. Their views, expertise, and perspective on antibiotic use and resistance are likely to have an impact on how they prescribe. It has been proposed that clinical practice indicators used to assess the quality of antibiotic prescribing are influenced by the mindset and expertise of doctors. According to the findings of a Spanish study, variables influencing general practitioners’ prescription of antibiotics include lack of information about ABR, a complacent attitude toward patients, and fear of infection-related problems. Workload and working in emergency rooms have also been recognized as key factors influencing antibiotic prescribing in addition to attitudes.

5) Inadequate training for healthcare professionals

Inadequate ongoing professional development throughout professional careers, inadequate teaching on antibiotic prescribing throughout medical education, and later during the early stages of clinical practice, can all contribute to incorrect antibiotic prescribing. The WHO recently emphasized the value of undergraduate instruction in responsible prescribing practices. A recent study on self-reported preparation among final-year medical students in 29 European nations revealed that, on average, 66.1 percent of students sought more instruction on judicious or general antibiotic usage (varying from 20.3 percent in Sweden to 94.3 percent in Slovakia).

6) Pharmaceutical promotion

It is also thought that pharmaceutical advertising leads to more unreasonable prescriptions. According to EU regulations on pharmaceutical promotion, advertising cannot be deceptive and must be in line with the information about the medication that has been approved. Additionally, it specifies that the Member States must make sure that there are suitable and reliable ways to keep an eye on drug advertisements. It has been suggested, however, that, globally, even nations with sufficient resources for regulatory oversight differ substantially in the degree to which they effectively monitor pharmaceutical promotion and enforce laws with sufficient sanctions. Healthcare professionals’ prescription and dispensing decisions are influenced by pharmaceutical advertising. The results of numerous research that were part of a systematic analysis that was published in 2010 demonstrated that doctors’ exposure to information from pharmaceutical corporations is linked to increased prescribing frequency, higher prices, and lower prescribing quality. However, it is important to recognize the variability of the included research.

7) Deficiency of local antibiotic sensitivity and specificity data and timely and appropriate screening tests

Lack of adequate diagnostic tests to quickly identify the organism and its antibiotic susceptibility profile, direct antibiotic prescribing at the point of treatment, and minimizing the requirement for wide spectrum antibiotics is a major issue that contributes to improper antibiotic prescription and use. Since conventional culturing and susceptibility testing takes time, empiric prescription almost invariably comes before culture results.

Various European nations have different levels of regional antibiotic susceptibility data for the most prevalent bacteria available to medical professionals. Only statistics from a few hospitals in a given geographic area are reported by many nations. As a result, the sample cannot be considered representative and may not reveal regional variations within a nation.

8)  Role of the pharmacist

Pharmacists in community and hospital settings offer counseling (advice, information, and help) on the safe, effective, and logical use of medications as part of the regular dispensing procedure. According to WHO research, pharmacists are among the healthcare professionals best suited to combat ABR. Pharmacies play a crucial role in advising patients on symptomatic self-care without antibiotics or in referring them to doctors for examination. They are frequently patients’ initial point of contact with the healthcare system.

According to a study, pharmacists blamed attitudes and/or factors like acquiescence, a lack of continuing education, and the external responsibility of doctors, dentists, and the National Health Service for the issue of antibiotics being prescribed without a prescription and its connection to ABR. According to Portuguese research on community pharmacists, a pharmacist’s expertise and attitudes may affect how likely they are to provide antibiotics without a prior prescription from a doctor. The attitudes that had the biggest effects on the tendency to give out antibiotics without a prescription were complacency toward patients, responsibility to others, and dread or caution. In situations of dental disorders and ailments (38.1%) and urinary tract infections (36.2%), pharmacists were most likely to administer without a doctor’s prescription. Pharmacists may prioritize patients’ health outcomes and give antibiotics without a prescription if they are aware of their financial condition and the barriers preventing them from receiving therapy.

Steps required for minimizing the irrational use of Antibiotics

  • Increase Public and Healthcare Professional Awareness of Antibiotic Resistance and Rational Use
  • Optimize Antibiotic Use
  • Strengthen the Data about Antibiotic Use and Resistance
  • Mapping Information Regarding Antibiotics Use and Resistance
  • Support Public Health Driven Models of Innovation for the Development of Antibiotics
  • Stronger Regulations Governing Pharmaceutical Promotion
  • Policy Coherence and Adequate Implementation

Conclusion

ABR has serious negative effects on both health and the economy. The factors that have been identified as irrational antibiotic drivers highlight how complex the issue is and how several approaches must be taken to solve it. Despite the enormous number of initiatives and actors working on ABR, they all stress the need for immediate action to combat the disease, for international, cross-sectoral collaboration, public and healthcare professional education, and most importantly, for the adoption of a One Health approach. To improve public and animal health, as well as the economics of Europe and its member countries, it is important to approach humans, animals, the food chain, and the environment as a single, integrated system.


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