Today is European Antibiotic Awareness Day. The aim of this day is to provide an annual opportunity to raise awareness about the threat to public health of antibiotic resistance and how to use antibiotics responsibly.

Antibiotics, also known as antimicrobial drugs, are medicines that can kill or inhibit the growth of bacteria to cure infections in people, animals and sometimes plants. A worrying problem occurs when some bacteria, which are normally susceptible to antibiotics, become resistant. Resistant bacteria survive in the presence of the antibiotic and continue to multiply, causing longer illness or even death. Infections caused by resistant bacteria may require more care as well as alternative and dearer antibiotics, which may have more severe side effects.

Antibiotic resistance is a natural occurrence caused by changes in the bacterial genes. However, excessive and inappropriate use of antibiotics accelerates the emergence and spread of antibiotic-resistant bacteria. When exposed to antibiotics, susceptible bacteria are killed and the resistant ones can continue to grow and multiply. These resistant bacteria may spread and cause infections in other people who have not taken any antibiotics.

This process is encouraged when antibiotics are used for the wrong reasons: most colds and flu are caused by viruses against which antibiotics are not effective. In such cases, the condition is not improved by taking antibiotics. Also, antibiotics don't lower fever or symptoms like sneezing. Other ways in which antibiotics can be used incorrectly include shortening the duration of treatment, lowering the doses or not complying with the right frequency (taking the drug once a day instead of two or three times a day as directed). As a result, there will not be enough drug in the body and the bacteria will survive and may become resistant.

Treating infections due to resistant bacteria is a challenge; it may delay getting the right treatment to patients and may result in complications, including death. The situation is getting worse with the emergence of new bacterial strains resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). Such bacteria may eventually become resistant to all existing antibiotics. Without antibiotics, we could return to the "pre-antibiotic era", when organ transplants, cancer chemotherapy, intensive care and other medical procedures would no longer be possible.

Before the discovery of antibiotics, thousands of people died from bacterial diseases, such as pneumonia or infection following surgery. It was no surprise therefore that they were dubbed the "miracle drugs" when they were discovered more than 50 years ago. Since then, more and more bacteria, which were originally susceptible, have become resistant. Because resistance is increasing and few new antibiotics have been discovered and marketed in recent years, the problem of antibiotic resistance is now a major public health threat.

Keeping antibiotics effective is everyone's responsibility. Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations. On this basis, it is important to know when it is appropriate to take antibiotics and how to take antibiotics responsibly. Everyone can play an important role in decreasing antibiotic resistance.

Patients should follow their doctor's advice and when possible, reduce the risk of infection through appropriate vaccination. Washing hands regularly, for instance after sneezing or coughing and before touching other things or people, helps reduce the spread of disease. Antibiotics should never be sought or obtained without a prescription, which incidentally is illegal. Patients should not pressure their doctor or pharmacist to prescribe or dispense antibiotics simply because they feel they need them nor resort to unused "leftovers".

The responsibility is not just the patient's. Doctors should only prescribe antibiotics when necessary, according to evidence-based guidelines. When possible, it is important to prescribe an antibiotic that is specific to the infection and not one that is "broad spectrum" and hits the "useful" microbes in our body which are there to help the body function properly. Furthermore, it is not only antibiotic use in humans that is a concern. Indeed antibiotics used to treat and prevent bacterial infections in animals belong to the same chemical groups as those used for humans. Therefore, animals may acquire bacteria that are resistant to antibiotics also used against human infections and contribute to the problem.

Certain resistant bacteria that are associated with food consumption, such as campylobacter or salmonella, may be transferred from animals to humans through food. People may also acquire resistant bacteria from direct contact with animals. However, the major cause of antibiotic resistance in humans remains the use of antibiotics in human medicine.

Surveillance data show that antimicrobial resistance is a growing public health problem in European hospitals and communities. To address this public health concern, the Council of the European Union issued a recommendation in 2001 asking countries to put in place actions to ensure prudent use of antibiotics.

Some countries - including Malta - have launched national programmes, including public awareness campaigns. The success of such initiatives depends on their acceptance by all parties: patients, doctors and the public. We can all contribute, through better use of antibiotics, to ensure that both we and our children will continue to benefit from these "miracle drugs".

Dr Borg is chairman of the National Antibiotic Committee.

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