Greece: Antibiotics nation

As one does not grab a sledgehammer to crack a nut, neither does one use antibiotics to deal with a simple infection, doctors in the field are fond of saying. But reckless and indiscriminate antibiotic use is a ticking time bomb that might in time blow up the foundations of public health, with fears growing that in a few years’ time, doctors may no longer have weapons in their pharmaceutical armory to stamp out serious infections. The only solution, experts say, is to educate both doctors and the public. The latter especially often labor under the delusion that antibiotics are a panacea. For example, only 40 percent of Europeans know that the drugs are ineffective in tackling viral infections, according to Eurobarometer 2001. According to statistics given to Kathimerini by the president of the Institute of Pharmaceutical Research and Technology (IFET), Georgios Dimopoulos, Greece is among the countries with the highest consumption of antibiotics. Moreover, data from all of Europe, collated by the European Surveillance of Antimicrobial Consumption, shows that this country came second in antibiotic use during the year 2001. Antibiotics are among the top three of most widely consumed categories of medicinal drugs, and use is constantly growing. Specifically, based on sales in 2003, antibiotics are in third place with a share of 11.45 percent, and have shown an average growth rate of 11.29 percent over the last five years. «Overconsumption of antibiotics,» said the president of the Hellenic Society for Infectious Diseases (EEL), Panayiotis Gargalianos, «leads to increasingly resistant strains of bacteria to medicines. As a result, it is more and more difficult to choose a suitable mode of treatment. Thus, doctors are forced to administer antibiotics they set aside for exceptional cases.» And he added, «If, in this way, we render all antibiotics useless, in a few years’ time, patients will be dying from the lack of available drug treatment.» It is a worldwide problem, Gargalianos said, but in Greece there is the impression that a large percentage of doctors were either prescribing the wrong antibiotics or prescribing in cases when they were not needed, such as for viral infections. Moreover, in contrast to other countries in Europe and North America, antibiotics are over-the-counter drugs. Why does the bad use of antibiotics differ from that of other medicines? Gargalianos pointed out that «if you administer, for example, an unsuitable blood pressure-lowering drug, then the only one harmed is the patient. But if you administer an unnecessary antibiotic, you harm the patient, his family, his town and the entire country. The microbe, which thus acquires resistance, can then spread easily throughout the population, even via a simple handshake.» Gargalianos said that the nosocomial pathogen Pseudomonas has already acquired such a resistance. «Within society (outside the hospital), staphylococcus and enterococcus are also showing resistance. Ordinary bacteria involved in urinary tract infections, such as coliforms, are developing resistance to antibiotics used as a first line of defense.» Nor can a solution to the problem be expected from pharmaceutical research, «which has not held out much hope for the production of new groups of antibiotics, nor are there expectations that it can produce them,» said Gargalianos. Dimopoulos felt the state should be responsible for monitoring antibiotic use, as well as informing doctors, taking measures and carrying out inspections. «In this context, IFET has undertaken to monitor sales of pharmaceuticals for human and veterinary use, carry out surveys and participate in the relevant European programs. Moreover, it has set up an information campaign to educate the public in the correct use of antibiotics,» he said. A guide addressed to doctors, titled «Infectious Diseases and Their Treatment,» which will give guidelines on prescribing medicines, is also in the pipeline. The news is not all bad. «Greek pediatricians,» said Gargalianos, «have conformed to the guidelines for the correct use of antibiotics to a greater extent than pathologists for adults.» Especially, doctors need to know that they can administer antibiotics only if they are certain that the infection is bacterial in origin and the antibiotic will strike at the source of the infection. «And they should always bear in mind the repercussions that can arise with the use of antibiotics,» Gargalianos concluded.