Issue link: https://maltatoday.uberflip.com/i/1057934
4 maltatoday | SUNDAY • 2 DECEMBER 2018 KARL AZZOPARDI THE winter season is well and truly underway, and as the days get shorter and colder, flu and cold cases will start surging up- wards. But the overdependence of Maltese patients on antibiotics is set to become a major con- cern as a report by the European Centre for Disease Prevention and Control has shown that in 2016, Malta topped the Euro- pean list for antibiotic use in hospitals. The ECDPC based its statistics by looking at the number of an- tibiotic 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 over- use of antibiotics for simple cas- es 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 pre- scribed. Locally, broad-spec- trum antibiotics are popular with doctors but they have a greater risk of resistance," she said. The problem with improper use of antibiotics is the in- creased antimicrobial resistance (AMR), which is caused when the bacteria mutate and thus are no longer destroyed by the an- tibiotics. Gauci said that there is a way to combat the issue of improper use of antibiotics. "Since anti- biotic use is the main driver for AMR, the key intervention is better and more judicious pre- scribing of antibiotics as well as better infection control practic- es like hand washing in hospitals and other healthcare settings to prevent spread of resistant bac- teria," she said. Gauci said overuse is driven by the incorrect prescribing by doctors, such as using antibiot- ics 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 circum- stances of those requesting an- tibiotics. "It's easy not prescrib- ing antibiotics, but if someone comes to me requesting them and I hesitate from doing so, they will just go to the next doc- tor. It's a vicious cycle," he said. Schembri Wismayer pointed at the two types of antibiotics prescribed: first-line antibiot- ics are protocol antibiotics pre- scribed for a particular condi- tion; 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 an- tibiotics were being prescribed than necessary, the GP agreed but said that one must also con- sider that people are living long- er thanks to such medications. "Anti-vaccination campaigns around Europe have also con- tributed to the wider spread of bacteria around Europe… and so to the further use of antibiot- ics," he claimed. But how can ordinary patients cut down on 'needing' antibiot- ics to cure their illnesses? Schembri Wismayer pre- scribes the daily apple… or sim- ply, 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 edu- cate people that not all sickness- es can be cured with antibiotics must also be launched." The Superintendence of Pub- lic Health recently announced a public consultation on a Na- tional Strategy and Action Plan for the Prevention and Contain- ment of Antimicrobial Resist- ance in Malta. The strategy is a cross-sectoral response to the threat of AMR in Malta and will look to control and possibly re- verse current AMR trends. British experts who carried out a study on the medical wis- dom 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 unneces- sary risk from antibiotic resist- ance when treatment is given for longer than necessary, not when it is stopped early," said Profes- sor 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 stop- ping 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 anti- biotics sooner is a safe and ef- fective way to reduce antibiotic overuse. There are notable ex- ceptions for some types of an- tibiotic, 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." NEWS The European Commission is looking for a provider of for the premises of the EU-House in Valletta, Malta. Security Guard & Reception Services The Contract Notice for the restricted tender procedure ref PR/2018-19-SEC/LAV was published on 27 November 2018 in the Official Journal of the European Union, OJ/S S228. Deadline for the submission of requests for participation is 11 January 2019. All relevant information can be found at: https://etendering.ted.europa.eu/cft/cft-display.html?cftId=4221 REQUEST TO PARTICIPATE Apples, not antibiotics, should be frontline as colder season sets in "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."