Apples, not antibiotics, should be frontline as colder season sets in

The winter season is well and truly underway, and as the days get shorter and colder, flu and cold cases will start surging upwards.

But the overdependence of Maltese patients on antibiotics is set to become a major concern as a report by the European Centre for Disease Prevention and Control has shown that in 2016, Malta topped the European list for antibiotic use in hospitals.

The ECDPC based its statistics by looking at the number of antibiotic doses (known as DDDs) consumed daily per 1000 people per day. Malta topped the list with 2.9 doses per 1,000 people per day, in comparison to the European average of 2.1 doses per 1,000 inhabitants per day.

The Superintendent for Public Health, Dr Charmaine Gauci, confirms the problematic overuse of antibiotics for simple cases of illness and their popularity with GPs.

“Local use of antibiotics has increased in the community as well as in the hospital over the past years. Just as important is the type of antibiotics prescribed. Locally, broad-spectrum antibiotics are popular with doctors but they have a greater risk of resistance,” she said.

The problem with improper use of antibiotics is the increased antimicrobial resistance (AMR), which is caused when the bacteria mutate and thus are no longer destroyed by the antibiotics.

Gauci said that there is a way to combat the issue of improper use of antibiotics. “Since antibiotic use is the main driver for AMR, the key intervention is better and more judicious prescribing of antibiotics as well as better infection control practices like hand washing in hospitals and other healthcare settings to prevent spread of resistant bacteria,” she said.

Gauci said overuse is driven by the incorrect prescribing by doctors, such as using antibiotics for viral conditions such as flu, colds and sore throats.

GP Mark Schembri Wismayer said that to truly understand the problem of AMR, one has to comprehend the social circumstances of those requesting antibiotics. “It’s easy not prescribing antibiotics, but if someone comes to me requesting them and I hesitate from doing so, they will just go to the next doctor. It’s a vicious cycle,” he said.

Schembri Wismayer pointed at the two types of antibiotics prescribed: first-line antibiotics are protocol antibiotics prescribed for a particular condition; second-line antibiotics are used when the first line is deemed ineffective. “Both sets are different from one another, as when prescribing antibiotics, it is not a question of dose but rather the type, as increasing dosage does not affect immune bacteria,” Schembri Wismayer said.

Asked if he felt that more antibiotics were being prescribed than necessary, the GP agreed but said that one must also consider that people are living longer thanks to such medications. “Anti-vaccination campaigns around Europe have also contributed to the wider spread of bacteria around Europe… and so to the further use of antibiotics,” he claimed.

But how can ordinary patients cut down on ‘needing’ antibiotics to cure their illnesses?

Schembri Wismayer prescribes the daily apple… or simply, a healthy lifestyle. “A fitter individual would normally have a healthier immune system. If the body’s natural defence works better, doctors wouldn’t have to revert to antibiotics,” he said.

“A stronger campaign to educate people that not all sicknesses can be cured with antibiotics must also be launched.”

The Superintendence of Public Health recently announced a public consultation on a National Strategy and Action Plan for the Prevention and Containment of Antimicrobial Resistance in Malta. The strategy is a cross-sectoral response to the threat of AMR in Malta and will look to control and possibly reverse current AMR trends.

British experts who carried out a study on the medical wisdom that an antibiotics course should be completed even when the sickness has been cured, said there was no evidence to back up such a claim.

“Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early,” said Professor Martin Llewelyn at Brighton and Sussex Medical School.

In his study for the British Medical Journal, Llewelln said antibiotics are vital to modern medicine but the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

“There is evidence that, in many situations, stopping antibiotics sooner is a safe and effective way to reduce antibiotic overuse. There are notable exceptions for some types of antibiotic, such as those used to treat tuberculosis.

“Completing the course also goes against one of the most fundamental and widespread medication beliefs people have, which is that we should take as little medication as necessary.”