In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
10 million people a year will die from bacteria that have become resistant to all antibiotics. Poland will not miss it – we are already in third place in the world in the abuse of these drugs. Right after the Americans and the French – says Dr. Magdalena Hurkacz, clinical pharmacologist from the Medical University of Wroclaw in an interview with Medont.
Poles try to treat colds, flu and coughs with antibiotics, although these drugs do not work. Last year, we bought 38,5 million packages of antibiotics, 2,5 million more than in the previous year, according to the Quintles IMS report. Are we drug addicts?
Dr. Magdalena Hurkacz: After the Americans and the French, we are the third society to overuse drugs, including antibiotics. Now comes the cold season and many people still believe that they can be cured with antibiotics. And 95 percent colds. cases is caused by a viral rather than a bacterial infection, the antibiotic is not effective in this situation. Although there is so much talk about it, we are still trying to heal ourselves, reaching for an antibiotic. The use of these substances may reduce natural immunity. So, thanks to antibiotics, not only do we not cure the infection, but we can open the way for pathogenic bacteria. In addition, many people self-medicate and, without consulting a doctor, reach for an antibiotic that, for example, was left over from the previous treatment. This is a disastrous procedure.
Antibiotics started a revolution in medicine. Thanks to them, we can fight bacterial infections and save human life.
Penicillin, the first antibiotic that Alexander Fleming discovered by accident in 1928, entered treatment in the 40s, which is not so long ago. It really changed medicine. She saved the lives of people, for example soldiers during the war, who had a bacterially infected wound. Before that, they would have been sentenced to death. Fleming’s discovery paved the way for further research on antibiotics conducted in the 60s, 70s and 80s. Until we got too far, we decided that we could cure all infections, because many diseases that we had not dealt with before could be cured with antibiotics.
They have become ubiquitous.
We began to use them to such an extent that we use them not only to heal people or animals. We add them to animal feed, i.e. they are in meat, for plant crops. I’ve read that even wall paints with antibiotics are produced. Antibiotics are with us constantly, we absorb them with food, we breathe them. So the bacteria that we need, the so-called comessal, and bacteria that are potentially pathogenic, are constantly in contact with the antibiotic. What are they doing? They are wonderfully resistant to this antibiotic.
Bacteria have produced many different types of communication with each other about how an antibiotic works. If some of them manage to produce such substances that counteract the antibiotic’s action, they pass this information on to the rest. There are many ways of transmitting information, so the next generations are already resistant to the antibiotic. And because bacteria multiply rapidly, resistance to antibiotics can build up very quickly. And today we have a problem. In the hospital, where, as a clinical pharmacologist, I try to help doctors in adjusting the appropriate pharmacotherapy, there are patients infected with bacteria resistant to all known antibiotics. In such a situation, it is very difficult to treat effectively. Unfortunately, people all over the world die from infections with bacteria that are resistant to all antibiotics we know.
Experts are sounding the alarm that antibiotic resistance is an avalanche phenomenon.
International microbiological societies have realized that medicine is beginning to have a real problem with it, that the post-antibiotic era has already arrived. Infectious or bacterial diseases appear that cannot be treated with known methods. And if we don’t do anything about it, the phenomenon will intensify. Common diseases, such as angina, which has been treated with an antibiotic so far, may soon turn out that we will not be able to deal with it.
The problem is various pathogenic bacteria, especially those that produce multi-drug resistance mechanisms. Strains of such microorganisms, e.g. Gram-negative is referred to as alarm. Recently, klebsielli has been registered in Europe, which came to us from Asia. This strain was called New Dehli, and it is resistant to many antibiotics that have been effective against these bacteria so far and have often been drugs of last resort. This and other resistant strains prompted microbiologists to sound the alarm.
Can something be done about it or will we go back to the time before antibiotics?
We have to manage somehow, there are several ways. The most important thing is to increase the patient’s awareness of antibiotic treatment. It is important to follow the treatment regimen recommended by your doctor.
We only take antibiotics when prescribed by a doctor. We do not take it from the home medicine cabinet, which unfortunately often happens. A few years ago, a survey on antibiotic therapy was conducted in Europe, and Poland also took part in it. The results of this study showed that patients like to self-medicate, put off the antibiotics prescribed by the doctor from the previous treatment, and when something hurts us later, it seems to us that it is some kind of infection, we dose this antibiotic ourselves. Unfortunately, by doing so, it is possible to produce bacteria resistant to the treatment.
Therefore, you should follow the doctor’s instructions, read the leaflets, which describe how to take an antibiotic so that it is safe and effective, what to combine it with and what not to combine it with. And it is necessary to take the antibiotic until the end, as prescribed by the doctor. The treatment must not be interrupted. If the doctor advised to take 10 days, then we take 10 days and under no circumstances should we leave it for later. You must not use an antibiotic as you see fit, because it seems to help with our infection. The role of the doctor and pharmacist is to draw the patient’s attention to the importance of the problem.
Another way to protect antibiotics is to personalize the treatment, e.g. by measuring the concentration of an antibiotic in the patient’s blood, and on this basis the optimal dose of the antibiotic is determined, but not necessarily in line with the manufacturer’s recommendations. This increases efficiency and safety.
Antibiotics that stop working are lost forever?
Not necessarily. In the world, if resistance to an antibiotic increases significantly, it is put on the shelf for some time, which means that the recommendations for indications are temporarily reduced, which means that it is used less frequently. For example, some antibiotics from the penicillin group developed a significant bacterial resistance and there was no point in using them. Therefore, their ordination ceased for a while. It turned out that after a while the bacteria that were resistant to these antibiotics naturally died out, and the next generation was sensitive to them.
How else to protect antibiotics?
I believe that the availability of some antibiotics in open treatment should be reduced. It is not because we want to prohibit GPs from treatment, but the point is that some treatments must be strictly controlled. In Europe, the lowest bacterial antibiotic resistance is in the Scandinavian countries, which are very rigorous in the use of antibiotics. In Great Britain, many of the antibiotics that you can get in our pharmacies are only available in hospitals. After all, the primary care physician often does not have the possibility to strictly control the therapy, especially when the patient uses the services of several doctors who may prescribe various medications or self-medicate the patient. And this favors the development of antibiotic resistance.
In Poland, the so-called hospital prescription, i.e. a list of drugs selected by doctors as the most effective and safe in a given patient population. In this list, antibiotics are often divided into groups according to the degree of availability, those that can be ordered by each doctor in the ward, those that must have the recommendation of the head of the ward, and those that the doctor must apply for, i.e. obtain the consent of the director of treatment and in detail. justify their use. The latter are reserved for resistant infections, for intensive care units or transplantation units. The application is reviewed by a microbiologist, clinical pharmacologist and the director of treatment. This, too, is a kind of antibiotic protection.
There is also EUCAST (European Committee for Antimicrobial Susceptibility Testing), an organization that studies and recommends which bacteria and antibiotics are effective. EUCAST provides such recommendations on an ongoing basis based on epidemiological data. Each hospital is obliged to report every infection, especially alert, dangerous to the environment from the point of view of epidemiology, to the sanepid and the register of infections. We also send information that a given bacterium is no longer susceptible to an antibiotic to EUCAST. They collect them from many countries and on this basis we know that, for example, Escherichia coli is already resistant to such and such antibiotics, so there is no point in using these agents.
Certainly, the law should be stricter in relation to animal breeders, so that they do not use antibiotics in excess. Grace periods should be strictly adhered to.
There is also the concept of rational antibiotic therapy.
Rational antibiotic therapy introduces the rules for the use of antibiotics. It consists in the fact that when it is impossible to wait for the results of a microbiological test or it is not possible to do it, e.g. in a clinic, then an antibiotic is used according to the recommendations with a wide range of activities. The idea is to “hit” with the drug’s effectiveness with a higher probability. And when you can perform a microbiological test, the so-called therapy is applied. targeted at the bacteria grown in the patient. Such action also “protects antibiotics”, but also our wallets, because each subsequent drug used in the patient when the previous one did not work, costs even several times more than if we used the “targeted” one right away.
The Eurobarometer shows that on our continent the Scandinavians know the most about the action of antibiotics, who, apart from Germans, Slovenes and the Dutch, use these medicines the least frequently.
That is why it is so important that we reach our patients with information about the consequences of inappropriate use of antibiotics. We must make everyone aware of what threatens us because of their misuse.