Popping antibiotics “just in case” may be symptomatic of a Maltese trait to avoid uncertainty, a characteristic so ingrained in the country’s psyche it has topped Europe’s league tables.

Whereas most Scandinavians are happy to let a sore throat or flu run its course... Mediterranean people tend to want a quick fix solution

A paper in an international medical journal has identified Malta’s high degree of “uncertainty avoidance” – the third highest in Europe – as one of the possible reasons why the country has the second highest rate of antibiotic consumption in the EU.

“As a country we find it difficult to tolerate everyday uncertainty. This also reflects itself in antibiotic practices,” Dr Michael Borg said, pointing out that 55 per cent of Maltese take at least one course of antibiotics a year, compared with 22 per cent in Sweden.

Dr Borg, who heads the National Antibiotic Committee, recently published a paper inthe Journal of Antimicrobial Chemotherapy, which identified that a significant proportionof incorrect antibiotic use in European countries can be predicted from their national cultural traits. It also examined how these characteristics need to be used to better plan awareness campaigns.

Dr Borg linked data from the 2009 Eurobarometer survey, which studied antibiotic practices in the EU, with a cultural model by a Dutch social psychologist.

Prof. Geert Hofstede pioneered the measurement of world cultures using consistent and fundamental dimensions. According to his model, high uncertainty avoiding cultures like Malta try to minimise the stress related to everyday uncertainties, by either ignoring risks or resorting to dogmatic or even irrational decisions. “Whereas most Scandinavians are happy to let a sore throat or flu run its course naturally and only seek treatment if it gets significantly worse, Mediterranean people tend to want a quick fix solution,” Dr Borg said. This trait extends beyond patients pressuring doctors to prescribe antibiotics, a common complaint of local GPs.

“It is not uncommon in Mediterranean countries, such as Malta, for antibiotics to be prescribed ‘just in case’ a secondary bacterial infection develops, even though there is no evidence of any benefit from such practices,” Dr Borg stressed.

The other cultural dimension Dr Borg found to be associated with incorrect antibiotic use in Europe is masculinity. “People in masculine cultures are said to live to work. In such situations people tend to press for antibiotics under the mistaken impression these drugs will help them return to their normal everyday activities quicker,” he added.

These revelations pose a huge challenge for health authorities, since changing cultural characteristics takes time, but Dr Borg is hopeful. France, which also exhibits high uncertainty avoidance, has managed to considerably reduce the prescription of antibiotics for colds and flu. But it took €100 million and six years to achieve this goal.

Using the same methods and materials adopted in the UK or in Scandinavia is unlikely to net good results, as Malta’s cultural mindset is different. “Our approach is to emphasise that all colds and flu, as well the vast majority of sore throats and mild coughs in adults, are caused by viruses which will never respond to antibiotics,” Dr Borg explained.

“Taking an antibiotic in this case is useless and only serves to increase your risk of developing resistant bacteria. We are also addressing medical colleagues and insisting they do not prescribe antibiotics for mild infections that are almost certainly viral in origin.”

How confident is he that the increasing trend in antibiotic prescribing can be reversed?

“I would be a fool if I said it will be easy. But we are confident we can continue to achieve better compliance among the public, as well as doctors and pharmacists. We have no choice if we want to continue to benefit from these weapons of mass protection.”

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