The consumption of antibiotics by the Maltese public outside of hospitals has dropped over the past five years but the island tops the list in Europe in terms of their use in hospitals, European data shows.
The figures, published yesterday by the European Centre for Disease Prevention and Control, show that in 2016 consumption in the general community decreased by a fourth.
The centre uses a World Health Organization statistical method to calculate consumption by looking at the number of antibiotic doses (known as defined daily doses or DDDs) consumed per 1,000 inhabitants per day.
According to the data, released to coincide with the 10th European Antibiotic Awareness Day, consumption in the community in Malta dropped from 22.5 DDDs in 2012 to 16.4 per 1,000 inhabitants per day in 2016.
This figure is below the European average of 21.9 doses.
However, antibiotic consumption in hospitals increased, placing Malta at the top last year, with 2.9 doses per 1,000 people per day vs the European average of 2.1 doses per 1,000 inhabitants per day. This ranges from 1.0 in The Netherlands to 2.9 in Malta.
The consumption figures help experts understand antibiotic resistance in Europe, as consumption is among the main factors responsible for resistance.
Although most courses of antibiotics are consumed in private households in Malta, antibiotic use in hospitals is a major driver of the emergence of the multidrug-resistant bacteria responsible for healthcare-associated infections.
Data released yesterday also shows that the prevalence of the superbug MRSA eased in Malta but the island remains one of the countries with the highest percentages of resistance.
In 2013, at least half of those with Staphylococcus aureus (SA) in Malta were resistant to antibiotics and thus had MRSA.
This dropped to 37 per cent last year, meaning out of the 97 patients with SA at Mater Dei Hospital and in the community last year, 36 were resistant (had MRSA).
In recent years, Malta managed to cut down on MRSA blood infections, with the numbers dropping from three patients every two weeks in 2009 to one patient a month in 2015. Resistance increased, however, in terms of E. coli (Escherichia coli), one of the most frequent causes of bloodstream infections and community associated urinary tract infections worldwide.
E. coli resistance in Malta increased from 8.7 per cent in 2013 (when there were about 242 infected people) to 14.6 per cent in 2016 (about 328 infected people).
Peter Zarb, antibiotic pharmacist at the infection control unit, said that E. coli could be treated unnecessarily by broad spectrum antibiotics prescribed by GPs within the community. Family doctors in Malta are this week being roped in for an information session as part of the local authorities’ awareness-raising programme.
The European Commissioner for Health and Food Safety, Vytenis Andriukaitis noted that with increasing resistance even to last-line antibiotics: “We face a frightening future where routine surgery, childbirth, pneumonia and even skin infections could once again become life threatening”.
“To preserve our ability to effectively treat infections in humans and animals, we need to bridge differences between EU member states and raise the level of all of them to that of the highest performer,” he added.
This was the key objective of the new EU One Health action plan against antimicrobial resistance adopted this June.
Misuse of antibiotics does not only have a negative effect on the person consuming them but affects global resistance.
Influenza is not caused by bacteria, so antibiotics do not treat it.
If you have...
■ a fever of at least 38˚C or 100˚F
■ painful glands in the neck
■ a cough and/or runny nose
■ and you are aged over 15 years
...then your sore throat is most likely caused by a virus and you do not require antibiotics.