Many antibiotics are produced from micro-organisms such as penicillin itself, which is produced by the fungi called Penicillium, or streptomycin from bacteria called Streptomyces. Additionally, modern chemistry allows the production of new antibiotics with different antimicrobial properties by the chemical alteration of existing antibiotics. Furthermore, some modern antibiotics have been created through purely synthetic means.
Earlier treatments for infections often consisted of the administration of chemicals such as strychnine and arsenic, and these are also highly toxic to humans! Modern antibiotics are crucial in modern medicine's armamentarium as they have no or few side effects and are highly effective against specifically targeted organisms. The first known crude use of antibiotics was by the ancient Chinese over 2,500 years ago. Many other ancient cultures, including the ancient Egyptians and Greeks, used antibiosis: the application of molds and plants to treat infections owing to their natural production of antibiotic substances. In fact, the antibiotic properties of the Penicillium mold were first described in France by Ernest Duchesne in 1897 but his work was largely ignored until Alexander Fleming's rediscovery of penicillin.
Research in the past decade has clearly shown that antibiotic overuse is a major public health problem and indeed, it has been estimated that at least 50 per cent of antibiotic prescriptions for children by doctors are unnecessary.
Why are we concerned about antibiotic overusage?
On a personal and practical level, parents should be aware that all medications may produce side effects. Indeed, one in one million penicillin prescriptions is fatal.
On a broader level, antibiotic overusage leads to antibiotic resistance. This means that doctors lose the ability to treat relatively simple bacterial infections that are acquired in the community. Moreover, bacterial antibiotic resistance decreases doctors' ability to deal with serious infections that require hospital treatment. For these reasons, doctors are repeatedly told to reduce overusage of antibiotics by health authorities and by the medical literature.
So why are antibiotics overprescribed?
Well, there are several reasons and these consist of parent factors and doctor factors.
• Parent factors
Most parents are unsatisfied if the general practitioner does not prescribe an antibiotic for a febrile illness and may then, in any case, find a pharmacy that provides an antibiotic without a doctor prescription. This is naturally illegal as pharmacists are legally only allowed to dispense and not to prescribe or treat, and antibiotic therapy is not minor therapy.
• Doctor factors
Doctors may worry that a child that appears to have a febrile viral infection may in fact be harbouring a serious bacterial infection, and that the parents may not bring the child back to be re-examined even if the child's condition deteriorates. In these circumstances, a doctor may prescribe an antibiotic "just in case". An economic factor is that doctors are generally very busy individuals who work in a competitive, private practice environment. Not meeting parent expectations may mean that parents may shift to consulting another doctor.
The situation is difficult to reverse as mathematical models predict that it would take years or even decades for substantial reductions in bacterial antibiotic resistance solely as a result of more prudent use of antibiotics. It will therefore take a very concerted effort by patients, parents and doctors to improve the current situation.
• Prof. Grech is a consultant paediatrician with a special interest in paediatric cardiology and has published extensively not only in paediatric cardiology but also in general paediatrics and other aspects of medicine. He is also the creator and editor-in-chief of the journal Images in Paediatric Cardiology (www.impaedcard.com). Prof. Grech lives in Pembroke with his wife, two children and a Siamese cat, and finds painting Maltese landscapes and seascapes a particularly relaxing pastime.