Editorial

Antibiotics (from the Greek anti, against, and biotikos, fit for life) are substances that destroy micro-organisms such as bacteria, fungi, protozoa or viruses when applied in high concentrations. Modern antibiotics are crucial in medicine's armamentarium as they have few side effects and are highly effective against specifically-targeted organisms.

However, research in the past decade has clearly shown that antibiotic overuse is a major public health problem. On a personal level, patients should be aware that all medications may produce side effects. On a broader level, excessive use of antibiotic leads to antibiotic resistance. This means doctors lose the ability to treat bacterial infections - dangerous organisms are being created that are resistant to many antibiotics, such as MRSA bacteria.

So why are antibiotics over-prescribed? There are several reasons and these consist of both patient and doctor factors. Most patients 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 wrong because pharmacists are legally only allowed to dispense and not to prescribe or treat and antibiotic therapy is not minor therapy.

Alternatively, doctors may worry that a patient that appears to have a febrile viral infection may, in fact, be harbouring a serious bacterial infection and that the patient may not return for re-examination even if the patient'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 patient expectations may mean that parents could shift to using another doctor.

However, it is time for action as the ease with which doctors prescribe such drugs, and their availability from pharmacies, sometimes "over the counter" (and, therefore, illegally - up to 10 per cent of all antibiotics sold in Malta), have made this country the second highest consumer of such drugs in the EU. A survey last December showed that, in the previous year, about 55 per cent of individuals admitted to taking antibiotics. This rate was only surpassed by Italy, at 57 per cent. The EU average is much lower at 40 per cent and this contrasts unfavourably with Malta where it appears that the government and the medical authorities are not doing enough to cut the use of antibiotics.

Lack of education is evident as the study indicated that 17 per cent of the Maltese took antibiotics for a simple cold (where antibiotics just do not work) and another 26 per cent used antibiotics (again, fruitlessly) after contracting influenza. Even more worryingly, when asked whether antibiotics cured colds, 65 per cent of the public incorrectly answered that they did!

The EU report concludes that, although Malta has launched both a strategy and an action plan to reduce the inappropriate use of antibiotics, this has not been particularly effective so far and one of the reasons is that Malta's action plan lacks certain important aspects, including a prevention policy and a programme of education and training for health professionals.

The antibiotic resistance situation is difficult to reverse because 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, doctors, the government and the medical authorities to improve the prevailing situation.