It is a warning that medical experts have been repeating for years: the world is running out of antibiotics, and urgent action is needed to avert what the World Health Organisation has called “the greatest microbiological crisis of the 21st century”.
A 2010 Eurobarometer survey had found that Maltese were more likely to use antibiotics than many of their European peers
The crisis stems from both the demand and supply ends of the chain, with consumers often misusing existing antibiotics and pharmaceutical manufacturers not developing enough new antibiotic strains.
Chronic overuse of antibiotics – a 2005 WHO study calculated that at least half of all antibiotic use in the US and EU was unnecessary – has led to the emergence of antibiotic-resistant bacteria such as ‘superbug’ MRSA.
Last Friday, The Times reported the findings of an EU study which found that Malta was one of four EU states with the highest incidence of MRSA, which kills over 25,000 people in the EU every year.
A 2010 Eurobarometer survey had also found that Maltese were more likely to use antibiotics than many of their European peers, with 55 per cent having used antibiotics over the previous year compared to the EU average of 40 per cent.
Although the figures may appear disheartening, progress is being registered. MRSA incidence, although still very high, is falling, while over-the-counter antibiotic dispensation has been sliced down from 13 per cent in 2001 to close to the EU-average of four per cent last year.
According to Mater Dei senior pharmacist Peter Zarb, antibiotic misuse “occurs at three levels: patient demand, over-prescription by doctors, and the use of leftover antibiotics”.
Part of the problem, he said, was cultural, with many people thinking that unless a doctor prescribed them an antibiotic they had not been well-served. “Old habits die hard.”
A 2008 study had found that over 40 per cent of all doctor’s prescriptions were for antibiotics, placing Malta third among 19 surveyed European countries.
Mr Zarb, however, cautioned against local alarmism. “The problem is a global one. In the US, for instance, several doctors over-prescribe antibiotics to protect themselves from potential litigation.”
One pharmacist, speaking on condition of anonymity, said that customers often complained when she refused to hand out antibiotics without a prescription.
“They say they’ll take their business elsewhere, to other nearby pharmacies which have little qualms about handing out antibiotics,” she said.
There are also growing concerns over the effects antibiotic-fed livestock may be having on antibiotic resistance. Antibiotic residues can be found in dairy products or meat of animals which have been treated with antibiotics.
The need for further information in this field has prompted the EU into instigating a European-wide project, collecting data on the use of antibiotics in animal husbandry.
Malta has a national antibiotic policy for use within state-sponsored healthcare, as well as a national antibiotics committee to better assess local antibiotics use.
But while education campaigns and stricter regulation enforcement can help curtail local misuse, issues concerning a lack of new antibiotics must be tackled on an international level.
Between 1940 and 1962, more than 20 new classes of antibiotics were marketed. In the 40 years since then, only two new classes have emerged, with other new antibiotics being modified versions of already-existing classes.
The dearth of new antibiotics shows no sign of easing. US-based antibiotic resistance NGO React have revealed that among the world’s top 15 pharmaceutical companies, only five drugs in their research and development pipeline are anti-bacterials.
Despite the urgency of the problem, funding levels for research into new antibiotics remain far behind those of other pharmaceutical categories, such as oncology or HIV-related antiretroviral drugs.
Part of the problem is that investing in antibiotic research is not financially lucrative enough for pharmaceutical companies. Antibiotics are short-term drugs, used by patients for a couple of weeks at most. They also become obsolete once patients develop resistance to them, and research has shown that doctors are often reluctant to prescribe new antibiotics.
Industry experts have argued that public health measures to limit antibiotic use deter pharmaceutical companies from investing in antibiotic research, ironically propagating the antibiotic crisis by creating a conflict between preserving existing antibiotics and developing new ones.
In the meantime, prudent use of existing antibiotics is needed, said Mater Dei Hospital infection control unit consultant Michael Borg.
“The cupboard in terms of research is quite bare, so it is vital we take care of the drugs we have now because they will need to serve us for the next 10 years if not more.”