Sir Alexander Fleming raised the alarm regarding antibiotic overuse as early as 1945, when he warned that the “public will demand [the drug and] … then will begin an era … of abuses”.
In 2016, there are several once-manageable illnesses that can lead to life-threatening predicaments due to high rates of antimicrobial resistance (AMR).
The Organisation for Economic Cooperation and Development (OECD) has reported Australia’s consumption of antibiotics to be higher than the average of 29 included countries. Australia’s antibiotic prescribing rate was the 8th highest and was more than double that of countries prescribing the lowest volumes of antibiotics.
From the 60 antibiotics available in Australian hospitals to treat infections, more and more fail to prevent the proliferation of previously manageable infections. The proportion of e-coli bugs that cause urinary tract infections that are multi-drug resistant rose from 4.5 per cent in 2008 to 7.2 per cent in 2010.
Greece also tops the list of countries with the highest use of antimicrobial agents, presenting one of the highest antimicrobial drug resistance proportions in Europe.
Since 1950, national law forbids the dispensing of antibiotics ‘over the counter’ without a prescription in an effort to preserve the efficacy of these classes of antimicrobials, however, it is generally accepted by the public that antibiotics can be acquired from pharmacies by direct purchase or by retrospectively providing one. In Greece, there still is no control of the actual practice and in effect the law is not implemented.
In a recent study by www.eurosurveillance.org it was found that antibiotics can be very easily bought in Greek pharmacies without prescription. No pharmacist refused to dispense amoxicillin, cephalosporin or even ciprofloxacin without prescription, and none asked for any justification for the purchase.
“It is a common misconception for people to think that antibiotics can cure a cold or flu or even help them go through it smoothly,” Flora Fotoulis, pharmacist for NPS Medicinewise, tells Neos Kosmos.
“People in the community tend to think that all infections need to be treated with antibiotics. It is common to ask a healthcare professional such as a doctor or a pharmacist whether they would benefit from being prescribed an antibiotic for their cold or flu.”
In Europe, self-medication with antibiotics is a serious medicine issue. This may include buying antibiotics from a pharmacy without first consulting a doctor, or by using leftover antibiotics from a previous treatment. Unlike Greece, in Australia you can’t buy antibiotics without a prescription from a doctor.
“Self-medication of antibiotics is a concern as it can increase the risk of antibiotic resistance. Antibiotic resistance occurs when a bacteria mutates or changes to protect itself from an antibiotic. As a result, the mutated bacteria develops a resistant strain,” Mrs Fotoulis emphasises.
“The more antibiotics that are used or not taken correctly, the more chance bacteria have to change and become resistant to them. This can then make bacterial infections much harder to treat. If a person catches a resistant strain of bacteria, they will have the infection for longer, they might develop complications, or even worse, there may not be any treatment available to treat the infection, as the bacteria may become resistant to all antibiotics currently available for treatment. Our children could find themselves defenceless against the new superbugs.”
“This is a concern in our community because the prevalence of multi-resistance bacteria is increasing,” she says.
“If the issue of antibiotic resistance is not addressed it will leave us with no options for treatment of bacterial infections in the future.
“However, from my experience it is not only the people within the Greek community who are more susceptible to resorting to antibiotics for the common cold; it is a worldwide issue that needs to be addressed.
“It is important for people to understand that antibiotics do not work against viruses and will not treat the common cold and flu,” she explains.
Antibiotics are medicines which are used to treat infections or diseases causes by bacteria and do not kill viruses, Mrs Fotoulis insists, explaining that in the case of an infection caused by a virus, antibiotics will not help the patient recover faster, nor will they stop the virus spreading to other people.
“Most people who have a cold or flu will get better by themselves, because it is their immune system that helps them recover from the infection. If an infection is caused by bacteria, it is only then that a doctor will decide if an antibiotic is necessary to treat the infection.”
Overall, the worst ‘side-effect’ of antimicrobial medication misuse is antibiotic resistance, in which case bacteria start changing to counteract an antibiotic, becoming more resilient every time, creating more resistant superbugs. Meanwhile, over-consumption of cold and flu medications can cause dependency on nasal sprays and cough syrups.
“Cold and flu tablets treat the symptoms of the common cold such as headache, sore throat, runny or blocked nose, sneezing and coughing. They won’t treat the virus causing the infection,” she says.
“Common ingredients in cold and flu tablets include pain relievers (paracetamol, ibuprofen), decongestants (pseudoephedrine, phenylephrine), antihistamines (triprolidine, chlorpheniramine) and cough suppressants (dextromethorphan). Some people may not be able to take cold and flu tablets. This includes people with certain medical conditions, children, woman who are pregnant or breastfeeding and people who are taking certain medicines. It is important to check with your pharmacist or doctor whether you are able to take cold and flu tablets.”
Another prevalent misconception is that you can catch a cold in cold weather. The reason why cold and flu infections are more common in the winter than in summer is because in winter, people are more likely to be indoors escaping the cold weather.
“When people are in close proximity to each other, whether it be at home, at work, or on public transport, they are more likely to be exposed to viruses which cause the common cold and flu,” Mrs Fotoulis explains.
“Colds are usually passed from person to person by touching hands or objects (e.g. tissues and toys) or by breathing in droplets from sneezes and coughs.”
Buying an unfamiliar medicine over the internet and especially from overseas websites is another issue of concern raised by NPS MedicineWise.
Medicines bought overseas may have different ingredients from the brand sold in Australia, even if the brand name is similar.
“Doing that puts you at risk of taking a medicine that may not be suitable for you, has undesirable side- effects, or interacts with your other medications,” she explains.
“Overseas medicines may not meet Australia’s strict quality and safety standards, not to mention it is illegal for some medicines to be brought into Australia by post.
“If you cannot avoid buying prescription medicines from online pharmacies, buy only from sites that ask you to produce a valid prescription from a doctor. Never buy from sites that sell medicines without a prescription, or issue you with a prescription following an online consultation of some sort.”
To tackle these issues, the Australian government is providing funding to NPS MedicineWise to run an Antimicrobial Resistance (AMR) awareness and education campaign targeting both consumers and health professionals, with a particular focus on general practitioners as the main prescribers of antibiotics in Australia. The five-year campaign commenced in February 2012, with the aim of reducing current antibiotic prescribing rates by 25 per cent in general practice.
“NPS MedicineWise is committed to educating the public about the appropriate use of antibiotics to prevent antibiotic resistance, which can be prevented by ensuring you only use antibiotics when necessary,” she insists.
“It is always important to check with your doctor if an antibiotic is needed to treat an infection, and if an antibiotic is prescribed it is important to take the medication as instructed by the doctor.”
Antimicrobial Resistance (AMR) is an urgent global health priority, with the World Health Organisation (WHO) describing it as a looming crisis in which common and treatable infections are becoming life threatening. The prevalence of AMR is increasing both in Australia and internationally at a pace that exceeds the pharmaceutical industry’s capacity to develop new antimicrobial drugs.
* To find out more about prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, call NPS Medicines Line on 1300 MEDICINE (1300 633 424). Hours of operation are Monday-Friday 9.00 am-5.00 pm AEST (excluding public holidays). For further information on colds, flu and antibiotic resistance, go to www.nps.org.au/coldandflu.