Why you should be cautious about antibiotics: The case of Estonia

The World Health Organization (WHO) estimates that the number of deaths related to drug-resistant infections in 2019 was approximately 33,000 in Europe and 700,000 globally.

The large-scale and unnecessary use of antibiotics contributes to the development and spread of drug-resistant pathogenic bacteria. Statistical data also confirms that countries with the lowest rate of antibiotic consumption have fewer antibiotic-resistant bacteria.

Estonia is one of the countries where the rate of antibiotic consumption and thus also the spread of antibiotic-resistant bacteria has been relatively low. This was confirmed in a survey carried out by Jana Lass, a research fellow of clinical pharmacology at the University of Tartu, on the ambulatory use of antibiotics in Estonia over the past 11 years (2008–2018).

Apart from this, experts in the field express concern: while only 15 years ago the use of broad-spectrum antibiotics was relatively modest in Estonia, their use has been increasing. The survey reveals that in 2008 the use of broad-spectrum antibiotics was only 5 times the use of narrow-spectrum antibiotics, whereas in 2018 broad-spectrum antibiotic consumption was 16 times higher than that of narrow-spectrum medicines.

Narrow-spectrum antibiotics are mainly tailored to fight specific types of bacteria. At the same time, broad-spectrum antibiotics are designed according to the one-size-fits-all principle. However, attacking all bacteria at once instead of a single pathogenic bacterium is by no means a good idea, because even though the bacterial population usually keeps resistant bacteria in check, in this case the resistant bacteria have better chances for survival.

“Broad-spectrum antibiotics also attack non-pathogenic bacteria that are part of the normal human microbiota. Disturbance of the normal microbiota, for example, causes digestive disorders: diarrhoea and abdominal pain,” Jana Lass explained.

Preference towards broad-spectrum antibiotics

Regardless of digestive disorders, medical practitioners increasingly tend to prefer broad-spectrum antibiotics and no one knows exactly why. Irja Lutsar, Professor of Medical Microbiology at the University of Tartu, suggests that it may be attributed to human emotions.

She believes that the balance may often sway towards broader-spectrum antibiotics when a patient simply looks very ill. “The thinking behind it is that we’ll use a broad-spectrum medicine just in case, because the broad-spectrum antibiotic is probably more effective than a narrow-spectrum one,” Lutsar speculates. This choice, however, is rationally unjustified and facilitates the spread of resistant bacteria. Lutsar gives the example of Norway, where general practitioners do not have the right to prescribe broad-spectrum antibiotics and have to apply for special permission in each specific case.

Strong antibiotic with side effects

Jana Lass noted that while antibiotic consumption in Estonia seems exemplary from the outside – the use of antimicrobial substances here is rather modest compared to other EU member states ­­– outbreaks of antibiotic-resistant bacteria in Estonian hospitals are nothing that has not been seen before.

“These outbreaks are not very common, but they do happen at times, and in such cases we have no choice but to prescribe, for example, colistin, an antibiotic which has severe side-effects,” Lass said. She added that Latvia, for example, has to resort to the use of such strong antibiotics more frequently, and it would be better if the same did not happen in Estonia.

“If a patient has been found to have, say, a stem of a carbapenem-resistant Acinetobacter, we have to treat the patient with colistin, because it is the only antibiotic that is effective against the bacterium. Using it, however, results almost definitely in damage to the kidneys and very likely also to the central nervous system. Unfortunately, we have no other choice in such situations,” Lass said.

In order to not exacerbate the problem, the use of antibiotics must be monitored and, if necessary, regulated more effectively. We must bear in mind that the spread of resistant bacteria is further facilitated by the overall use of antibiotics in agriculture. The overall globalisation and travel also play a part: like all other bacteria, antibiotic-resistant ones also travel the world with people and trade.

How can you use antibiotics responsibly?

• Seek information about the medicine and its effect.

• Treatment with antibiotics does not follow the rule of “the poorer the health, the stronger the drug”. An antibiotic must be effective against the specific bacterium and should not attack the good microbes.

• Read the patient information leaflet and seek advice from your healthcare provider about the medicine.

• Start taking your prescription medicine as soon as possible.

• All the unused medicines, especially antibiotics, must be returned to the pharmacy to ensure that they will not end up as waste in the environment.

• Use only medicines prescribed to you personally and do not share your medicines with other people.

The research in this story was performed as part of the AMRRITA project. The Estonian version of this story was published in the science news portal Novaator.

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