Overuse of antibiotic creams is most probably caused by people deciding to use the ointment themselves and also passing the medicine to others when no prescription would have been issued, according to the health authorities.

The factor that “probably” led “to the most misuse” was unauthorised self-administration of topical applications from leftover tubes, they said.

Malta has one of the highest rates of usage of creams containing fucidic acid, which is considered to be the possible cause of a new strain of an antibiotic-resistant bacterium – MRSA – that, so far, has only been reported in Malta.

However, it is not only patients that should be blamed but also doctors and pharmacists. The Health Ministry said there was “an element of over-the-counter dispensing by pharmacists” and doctor’s prescribing habits, which were very high, the ministry said.

Antibiotic creams, such as Fucidin and Fucicort, can only be dispensed against a doctor’s prescription but in a recent exercise, The Times found seven out of eight pharmacies visited willing to sell the products over the counter.

The ministry said it had not received any reports or evidence of pharmacies illegally dispensing the creams in the past days. It added that random and unannounced spot checks and inspections were part of the routine procedures by the Medicines Authority.

The sale of antibiotics without a prescription carries serious penalties. If found guilty by the Superintendence of Public Health, who is the licensing authority, a pharmacist can be fined €9,317, in terms of the Medicines Act. If the pharmacist refuses to pay the fine, the matter would be taken to court and, if found guilty there, the pharmacist could face a fine of between €4,658 and €46,587 or a maximum of three months in prison or both a fine and imprisonment.

The ministry explained that, as a general rule, when any breach was found, the pharmacist was issued with a warning letter. “Further breaches will bring along imposition of a penalty as prescribed by law and reporting to the Pharmacy Council,” it said.

The overuse of antibiotic ointments “concerned” the health authorities who believe guidelines and an awareness campaign on their use would help. The National Antibiotics Committee is in the process of drafting such guidelines for health professionals. The plan is to publish them in November on Antibiotics Awareness Day.

“The guidelines will help professionals better understand the indications for the use of topical antibiotics, which will, hopefully, lead to a change in prescribing habits and a reduction in the amount of prescriptions issued. However, educational campaigns for other health care professionals and the public are also necessary and will continue to be carried out,” the health authorities said.

The link between the rare strain and overuse of antibiotic creams was highlighted in a study carried out by University student, Jeanesse Scerri, as part of her medical laboratory sciences degree supervised by Antibiotic Committee chairman Michael Borg.

With Malta having one of the highest levels of use of fucidic acid cream, Dr Borg has urged doctors to go slow in prescribing it, saying it was “vital” for pharmacists not to dispense it without a prescription.

Chamber of Pharmacists president Mary Anne Sant Fournier said the chamber was not the regulatory authority but condoned any selling without a prescription. It will issue guidelines and reminders to pharmacists.

She reiterated that the chamber “firmly believes that the greater majority of pharmacists are responsible health care professionals who are mindful of their legal and professional obligations and give a good service to their patients and clients”.

While the pharmacy was the only legal source of medicines to the public, “it is a well known fact that patients self-medicate, re-use, pass on and or borrow medicines from relatives and friends”.

However, the reported high usage of these antibiotic creams was due to several factors, not excluding dispensation by some pharmacists at their discretion, over-recommendation by doctors and excessive demands by patients, Ms Sant Fournier said.

The chamber said that any guidelines drafted by the Antibiotics Committee should be discussed with the professionals concerned before implementation. Also, such collaboration should be ongoing “and not sporadic to ensure maximum benefit, she said.