Antibiotic resistance is an increasing public health threat all over the world. To reduce this problem the use of antibiotics has to be balanced, meaning that antibiotics should be used only when they are needed and justified for therapeutic reasons, and not otherwise.

Antibiotic resistance is causing increased illness and preventable deaths, and the growth of infections from resistant bacteria in health care settings is a major concern. Every year in the European Union, Iceland and Norway, an estimated 25 000 patients die from a serious resistant bacterial infection, most of them in hospital. This number covers only about half of the 53 Member States of the WHO European Region: variable diagnostic capacity and incomplete data in the rest of the Region mean that the overall number is not known.

The increasing development of resistance is not only a threat to the outcome of treating bacterial infections but a serious risk to the success of some surgical interventions such as colon surgery, transplants and hip replacements, as well as many minimally invasive diagnostic interventions that take place under antibiotic prophylaxis.

If you are a doctor, veterinarian, or dentist, and prescribe drugs, you are responsible for using these life-saving drugs wisely to cure patients, and thus keep antibiotics effective. Overuse and misuse of antibiotics increase the risk of resistant bacterial strains developing by selective pressure or mutation. The transmission and spread of resistant bacteria between people, food animals, products or the environment can further contribute to the increased risk of antibiotic drug failure, leading to severe disease, deaths and increased costs.

What can you do

Doctors and dentists

Prescribe antibiotics only when needed and only as indicated by treatment protocols for the disease. Antibiotics do not cure viral infections – influenza, coughs and colds – and over-prescribing them inappropriately increases the emergence and possible spread of resistance.

Pharmacists

Do not sell antibiotics without prescriptions, nor in insufficient quantities to complete a course of treatment. Make sure that the patient has full instructions on how they should be taken and for how long, and understands that the entire course must be finished or the infection may return.

Nurses

Discuss the correct use of antibiotics with patients and make sure they take them according to the instructions, particularly finishing the course. Help to enforce rigorous infection control measures, to stop the spread of resistance.

Veterinarians

The use of antibiotics as a growth promoter is already banned in the European Union and other countries should consider this. Use antibiotics wisely in the veterinary sector and avoid giving antibiotics to healthy animals wherever possible.

What to say to patients

Many patients think they need an antibiotic to feel better, even though they have a viral infection. This puts pressure on you. As a health professional, it is important to talk about the illness with the patient and discuss whether an antibiotic is the right treatment.

• Explain that antibiotics do not treat viruses and can make the patient more vulnerable.
• Recommend symptomatic relief and common practices for fever, influenza, runny noses, headaches and other symptoms that go hand in hand with common illnesses and infections.
• Tell patients what you find on examination, such as clear lungs or no signs of ear inflammation, to allay some of their concerns.
• Explain your diagnosis and how common infections develop and usually improve within 72 hours. Give advice on how to recognize more severe symptoms.

If you do prescribe antibiotics

• Follow national treatment protocols if they exist to ensure the appropriate treatment regimen and dose to prevent the emergence of drug resistance.
• Make sure the patient understands the importance of following the prescription exactly, and completing the treatment.
• If dealing with life-threatening infections in hospital, the use of antibiotic drugs should ideally be based on culture results.
• Remember that for certain medical and surgical interventions, bacterial prophylaxis with antibiotics can in many cases be as short as 24 hours.
• Veterinarians should not prescribe antibiotics as promoters of animal growth. Only use antibiotics when needed.

Contribute to preventing infections

• All health care workers, particularly nurses, should promote hygiene, especially hand hygiene.
• Preventing infections is the key to the efficient control of resistant bacteria. In hospitals or clinics, this means a rigorous infection control programme.
• Establishing antibiotic and infection prevention committees in health care settings allows better detection and reaction to hospital-acquired infections and effective treatment of them.
• National recommendations from a national antimicrobial resistance committee may give guidance for the prudent use of antibiotics, whether in hospitals or outside.
• If you are involved in teaching, use the opportunity to speak about the prudent use of antibiotics and the dangers that lie in overuse and misuse.

Some facts on antibiotic resistance

Ninety per cent of antibiotic prescriptions for people are issued at the primary care level and given for common infections such as urinary tract, respiratory tract or skin infections. Many upper respiratory tract infections are not caused by bacteria and antibiotics will not benefit the patient.

Methicillin-resistant Staphylococcus aureus (MRSA) often affects patients in hospitals and health care settings, leading to life-threatening situations, and in some countries over 25% of S. aureus samples are resistant.

Evidence indicates that when low doses of antibiotics, such as tetracycline, are used in healthy chickens as a growth promoter, this quickly (within 36 hours) leads to the excretion of resistant Escherichia coli, a common bacterial cause of infections in humans.

Of the 440 000 estimated multidrug-resistant tuberculosis (MDR-TB) patients per year in the world, 81 000 are estimated to be in the WHO European Region (20% of the global burden).

Points to remember

Antibiotic resistance could take us back to the pre-antibiotic era. Resistant disease-causing bacteria (or genes that induce resistance) are emerging and can spread rapidly between people, animals, products and the environment. Currently, very few new antibiotics are in the development pipeline.

Antibiotic resistance increases health care costs. If illnesses last longer and treatment is more complex, costs rise. This also places a heavier financial burden on families and societies. The European Centre for Disease Prevention and Control estimates that resistant bacterial infections cost European Union countries an additional €1.5 billion a year.

Definitions: antibiotics and antibiotic resistance

Antibiotics are a subclass of antimicrobial agents that are active only against bacteria. They can either be naturally derived from bacteria or moulds (fungi) or produced synthetically. Scientifically, “antibiotic” refers only to naturally produced antimicrobial agents, but this text uses the term to mean all drugs or agents against bacterial infections.

The emergence of resistance to antibiotics is a natural biological phenomenon that occurs when antibiotics are used. Antibiotic resistance results from the ability of bacteria to withstand attack by antibiotics, which can develop either through mutation or by acquiring resistance genes from other bacteria that are already resistant.

The main drivers of antibiotic resistance are the use of antibiotics, especially overuse (but also misuse and underuse) and the transmission and spread of already resistant bacterial strains or genes that carry the information on resistance.

For further information on antibiotic resistance, please contact:

Dr Bernardus Ganter
Senior Adviser, Antimicrobial Resistance, Division of Communicable Diseases, Health Security and Environment
WHO Regional Office for Europe
Scherfigsvej 8
DK-2100 Copenhagen Ø
Denmark
Tel.: +45 39 17 14 23
E-mail: bga@euro.who.int

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