Matthew Bonanno
Antibacterial creams still available over the counter
Buying antibacterial creams without a prescription remains effortless despite calls on pharmacists to stop the practice for fear of further spreading the superbug MRSA within the community.
The Times yesterday randomly popped into eight pharmacies to buy Fucidin, a popular antibacterial cream, after it was reported on Sunday that MRSA was present in the community possibly as a consequence of the abuse and misuse of antibiotic creams.
Martin Balzan, president of the Medical Association of Malta, had said both doctors and pharmacists were very aware of the issue and were therefore careful in the prescription and dispensation of antibiotics. Judging by yesterday’s experiment this does not seem to be the case.
Five of the pharmacists, in Valletta, Floriana and Ħamrun, readily handed Fucidin over the counter without either asking for a prescription or any questions related to its use.
The packaging of Fucidin itself advises that the cream should be used only “as directed by a physician”.
One pharmacist asked what the cream was for and when it was explained that it was intended for “an inflamed mosquito bite”, she pointed out that antibiotics were probably not necessary but still proposed an alternative – Fucidin H – which contains the antibiotic fucidic acid.
Another pharmacist said a prescription should be presented for this antibiotic cream but then consented to sell it when told the cream was for somebody else.
Only one pharmacy, in Floriana, refused to sell the cream without a prescription.
The chairman of the National Antibiotic Committee, Michael Borg, has appealed to doctors to cut down on prescribing antibiotic creams and urged pharmacists not to dispense such products over the counter without prescription.
His appeal follows a study that showed MRSA was found in the nostrils of 8.2 per cent of 450 healthy individuals who took part in the research.
Conducted by Jeanesse Scerri as part of her Medical Laboratory Sciences degree, the study identified a new strain that is different from all the MRSA strains previously encountered in Maltese hospitals. The new MRSA variant seems to have developed in the community and is resistant to penicillin anti-biotics and to fucidic acid.
Misuse and overuse of fucidic acid creams, such as Fucidin and Fucicort, were among the possible causes of a new strain of MRSA, an antibiotic-resistant bacterium. The strain is resistant to penicillin antibiotics in the same way other MRSA bacteria are, but it also carries a resistant gene for fucidic acid.
When contacted for a reaction to the fact that his appeal seemed to have fallen on deaf ears, Dr Borg said this was a worrying situation because all pharmacists knew these were prescription-only medicines.
“There is a common misconception that these creams can be used to treat anything. It seems there isn’t enough awareness on the risks of misusing or overusing antibacterial creams. Our education campaign on the subject definitely needs to be intensified. Everyone, from doctors to pharmacists and patients, has a role to play,” he added.
Dr Borg stressed that antibiotic creams were mainly recommended only for mild cases of erysipelas and impetigo. Both are superficial skin infections most commonly seen in babies and young children. They tend to cause inflamed blisters, typically around the nose, mouth and neck, that burst and form a weeping crust.
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Leonard Schembri
Aug 17th 2011, 19:39
I am glad that The Times is becoming investigative. Proset.
A.f Ellul
Aug 17th 2011, 18:07
Unti-biotics always been ordered by the doctors.for skin care there are other cream,but the most usefull skin cure cream has been destroyed.I can't mantion the name of this very usefull cream that is against insect bites,pimpils and specially protect the skin from burns and no blisters.That is, that good medicine is being destroyed so that we need to go to the doctors or to hospital for the little treatment.B.S.
Josephine Borg
Aug 17th 2011, 19:26
If you do not want to use aunty-biotics you can alway use grandma's treatment - Otorgu! It was home made and a bit messy but no bugs come.
Mr M Borg
Aug 17th 2011, 19:50
What was the name of this cream ?
Why can't you mention the name of this cream ?
H. J. Grech
Aug 17th 2011, 16:00
Reading this article I feel a bit hurt. Unfortunately I have been literally attacked by these tropical mosquitoes which have arrived to Malta in recent years. Having sensitive and delicate skin is no joke. My g.p. prescribed to me fucicort and it is the only way I relieve the utter itching and stinging feeling these mosquito bites leave. Some parts of my skin are like oven burns. Luckily enough the cream does work and I finished up spraying myself with insect repellent suitable for tropical climate! Obviously I have to be careful not to mix up the repellent with the cream.
Mr Christan Brincat
Aug 17th 2011, 15:15
The important point is: Anti-biotics create these viruses or super viruses.
Ms C Bartolo
Aug 17th 2011, 17:02
We're talking bacteria here, not viruses. Antibiotics only work against bacteria - that is why they should never be prescribed when one suffers from the common cold, which is caused by a virus not a bacterium.
Kenneth Galea
Aug 17th 2011, 15:11
In the States even Prozac is available over the counter. It will be totally impractical having to go to your doctor for every single cream or drug you need. There are numerous occasions when the patients can be their own doctors. I have to take a cocktail of drugs every day and I have a repeat prescription arrangement. As Mr M Borg rightly says why should he have to pay the EUR15 for the doctor's prescription when he knows for sure in this case he will be prescribed Fucidin. Apart from the unnecessary visits there is also the inconvenience and time involved. How can a pharmacist deny drugs with codeine to patients when we ask for them? It is absurd having to go to the doctor, pharmacists are qualified and they actually understand better than the doctors when it comes to the type of drugs, creams and anitbiotics to be used.
Mr M Borg
Aug 17th 2011, 13:38
Dr Borg is right , but so is the pharmacist who said that Fucidin is being used for " inflamed mosquito bites. "
I have been priscribed Fucidin by my doctor when I had such a bite. After that whenever I have an red, inflamed mosquito bite, I just use it without going to my doctor.
Fucidin costs €6.66 , a visit to my doctor whould add €15 to it. Why should I be made to pay an extra €15 when I know that the doctor will, as usual , prescribe Fucidin ?
Albert Ostimani
Aug 17th 2011, 14:09
I agree with you completely Mr M Borg. So why let the doctor steal your money so that you, as usual, can be prescribed the same thing? This is what the government should take into consideration.
Mr Anthony Azzopardi
Aug 17th 2011, 16:04
That is no excuse. Health Centre consultations are FREE
Mr M Borg
Aug 17th 2011, 18:24
@ Anthony Azzopardi
Can you imangine the crowds at Health Centres if we all had to go there for every mosquito bite !!
Mr Robert Agius
Aug 17th 2011, 19:31
@Mr Azzopardi - when was the last time you paid a visit to a clinic?
Michael Grech
Aug 17th 2011, 13:29
Are we sure that resistance to antibiotics is not mainly due to the antibiotics that are added to animal feeds?
Educating the general public on the proper use of antibiotics is also essential. The health professionals who come into direct contact with patients are doctors and pharmacists, and if patients ask for their professional advice, they are always ready to help. It is important for the patient to frequent the same health professionals so that their medical history is always taken in consideration when prescriptions are issued or medicine is dispensed.
We have an adequate health system with enough GP's and pharmacies. Most of the advice is given for free but the patient needs to understand that it is to his detriment and that of society if such system is abused through excessive pressure on the health professionals or without an adequate follow up of the advice given.
A. Gatt
Aug 18th 2011, 10:43
exactly ... I completely agree. What about the anyibiotics fed to animals ... That is the problem. I don't believe that overuse of cream on an inflamed mosquito bite is the problem. I'm allergic to most insect bites, and I cannot imagine having 8 or more inflamed bites and still do without the cream!
Ms C Bartolo
Aug 18th 2011, 12:09
@A.Gatt : an allergy isn't cured by antibiotics. If you are allegic to insect bites you need antihistamines not antibiotics. Regarding the antibiotics fed to animals and even sprayed on vegetables, yes, true, those facts are contributing to the problem as well. That is why organic produce should be encouraged. Hopefully, however, help can be given to keep the price of such products competitive.
A. Gatt
Aug 18th 2011, 12:59
Thanks Ms Bartolo,
I am not qualified in medicine, thus lack the expertise. However, for the infected mosquito stings my GP, who knows I prefer to avoid antibiotics as much as possible, prescribed Fucidin H for them and when a bee stings he gives me a full course of antibiotics due to inflammation.
Anyway, my point was mainly that we should go organic as has been said and avoid feeding animals antibiotics, I'm pretty sure that people are taking into their bodies much more antibiotics indirecly!
Heike Mozer
Aug 17th 2011, 12:24
Even when having a prescription and using it to get your medicine, the pharmacy does not hold that prescription, but allows you to take it with you. Basically this leaves the door open to use the same prescription more than once (at the same pharmacy or another one)... A proper weak point analysis on this whole procedure must be done before pointing fingers.. A regulated (monitored) procedure would mean patients don´t have a choice and have to obey the rules, Pharmacies are obligated to follow procedure and business is equally fair, as there will be no fear that they will lose business because of obeying the rules..
Bob Kelly
Aug 17th 2011, 12:24
Do prescriptions in Malta work the same way as the UK, where the fee for medicines is fixed when prescribed but the going rate when bought ‘over the counter?’
If so, then the prescribing argument will always be based on cost, rather than safety. Why pay Euro10 for an over-the-counter medicine if the prescribed cost is Euro5 [my costs so they may be way out, it's the principal I'm thinking of].
Mr Alex Ciantar
Aug 17th 2011, 11:52
This problem is caused by no other then the GP we have in Malta....... they prescribe drugs like we give smarties to kids, many a time I have been prescribed antibiotics for flu or a simple cold, or even the strongest antibiotic available for a small infection.
Most doctors in Malta openly admit that if you do not prescribe these drugs their patients (or should I say clients) well get upset and therefore lose them and their business.
The above has been proven a few months ago in this same newspaper that Malta was one of the highest in antibiotic abuse in the EU,
So there you have it !! A section of the medical profession has created the monster that we now have to kill now!!
Educate the nation on the abuse of drugs? of course, but first we have to go to the source of the problem and educated the GP's and impose harsh penalties if the prescribe (dish out) these drugs unnecessarily.......... at the end of the day they should have their patients interest at heart not not profit/commission
Anthony Borg
Aug 17th 2011, 12:52
Agree we you here. I have seen Doctors prescribe medicines to patients(especially those who are entitled to free medicines with the Pink Card) who are not even present! e.g A wife will go in the Health Centre/private clinic with a list of medicines her husband requires and the Doctor will prescribe these medicines for her husband, including antibiotics! Why? If it is a private Doctor, or else he/she will lose the client. If a Governemnt Doctor, he wants to get rid of the queue infront of him as quickly as possible with out any quarels or hassels. That is the reality!
Mario Desira
Aug 17th 2011, 10:57
And what about anti bacterial soaps which one buys from supermarkets etc which are having the same effect?
Research shows they are practically worse than useless and are probably compounding the problem of widespread antibiotics.
Ms D Galea
Aug 17th 2011, 10:56
Could it be possible that the MRSA has spread in the community via members of the staff working in the state hospital who end up acting as carriers?
I am here referring not just to nursing and medical staff but other staff including tea ladies , security and anyone handling hospital trolleys and hospital files who have access to all parts of the hospital.
Robert Grech
Aug 17th 2011, 16:09
Especially considering that the uniforms are taken home to clean.
Ms C Bartolo
Aug 17th 2011, 17:05
Of course members of staff are carriers - they carry the bacterium in their nostrils as is written above. The problem is that whereas staff members are checked every so often, visitors of hospitalized patients are not. It is impossible to avoid people being carriers. What is possible however is the creation of such "superbugs".
Stephanie Magro
Aug 17th 2011, 09:54
I am a pharmacist myself. People come into the pharmacy on a daily basis requesting all types of antibacterial preparations (from tablets to creams to eye/ear drops). During the five year pharmacy course I learnt that almost all medicines that are behind the counter are prescription only medicines, but then in reality this is definitely not possible to apply. I try to not dispense these type of medicines. However, this is never possible as patients say:
1) they called the doctor
2) the doctor always prescribes that type of antibiotic so what's the point to seeing a doctor
3) they will go to another pharmacy
... and the list goes on
During my first year of practicing, I always took a stand and never dispensed antibiotics over the counter. However, this always ended up in people shouting at me etc etc. So, I think, before blaming pharmacists and doctors, first we have to engage in a vigorous campaign to educate people. Secondly, I think all pharmacists have to agree on this matter because whenever I refuse to dispense antibiotics I always know that the patient got antibiotics from another pharmacy. Most pharmacists do it to increase their sales and to increase the customer flow in the pharmacy, but I don't think this is ethical.
Ms C. Dimech
Aug 17th 2011, 10:25
completely disagree with you, so what if a customer shouts at you. dispensing any form of medicinal that needs a prescription without a prescription is ludicrous especially for the reasons that you mentioned. God forbid all pharmacists had to reason the way you do!!!
Anthony Borg
Aug 17th 2011, 10:31
The problem is that most our pharmacies are owned by non pharmacists and hence only care about the profits they make. The employed pharmacists end up having to dispense these items cause they are afraid of the owner who at the end of the day sign their pay cheque! Above all this they are the only business left in malta where there is a certain amout of licences and hence no liberalisation here. At the end of the day it is the patients (and all the population in Malta for that matter) who will end up suffering if these resitant bugs increase in numbers, while all the pharmacy owners make money. Wake up Chamber of Pharmacists, protect your members!!
Kenneth Galea
Aug 17th 2011, 10:41
Hi Stephanie, I read your comments and you stike me as a practical pharmacist who is in touch with reality. Keep up the good work.
Stephanie Magro
Aug 17th 2011, 11:55
@ Ms C Dimech
I never said that I dispense everything just because someone raises his/her voice or if he/she threatens to go to another pharmacy. I just wanted to state the reality.
Joseph Grech Attard
Aug 17th 2011, 16:42
Stephanie you spoke the truth and nothing but the truth. Easier said than done. It's a similar situation with the doctors, whether we like it or not. Patients pressure doctors to prescribe antibiotics and, not to loose a patient to some other doctor who will do it, the doctor prescribes it. You don't do it once and you loose a patient, you don't do it twice and loose another, the third time you send everybody to hell and do it. But this does not hold only for prescriptions but also for medical certificates, etc. The private practice in Malta is in shambles, the private GP is the worst paid and the rule of the jungle prevails, with fee-cutting, etc to attract patients. 50 years ago one started talking of a Health Scheme. Now it has long been forgotten and is no longer on the politicians' agenda, who know quite well how private medicine works!
Kenneth Galea
Aug 17th 2011, 09:48
We want to liberalise the market rather than restricting it. It will be a pain in the backside if more and more products need to be accompanied by a medical prescription. The pharmacist should give a brief explanation to the patient and then it is up to the patient to use it appropriately. It is the responsibility of the patient at the end of the day, this also applies to a wide range of drugs. We cannot keep going to the doctor for a simple prescription when you can easily obtain the product over the counter. In the UK for example (though we are in Malta here) more and more products are becoming available over the counter, no prescription needed, though questions are asked normally by the pharmacist about the use of the product.
Ms Maria Mizzi
Aug 17th 2011, 10:48
You're right Mr. Galea, it is the patient's reponsibility but in this case the patient is harming everyone else besides himself and that's a huge responsibility.
Jason Falzon
Aug 17th 2011, 11:02
did you read the article in full mate? The misuse of fucidin is causing a new strain of MRSA resistant to penicillin.
This is not a case of liberalisation and restrictions, but more of prevention and careful use of medicine.
I Bugeja
Aug 17th 2011, 09:29
I should recommend Drug Store Sliema on this one. I am a client of theirs and although the pharmacist recognises my face, always asks for the prescription.
I always thought of it being a nuisance however this proves me wrong, well done.