Bugging bugs.

The inappropriate use of antibiotics and the increasing problem of antibiotic-resistant bacteria is a major public health concern [1].

Two papers published in the Scandinavian Journal of Primary Health Care, December 2014 reported on interesting aspects of the use of antibiotics [2,3].

A Danish study on an out-of-hours (OOH) primary care service revealed that of those who used this service 15% received antibiotic prescription. Most of the prescriptions (26%) were given after a clinical consultation. However, almost 11% of these prescriptions were given by telephone consultation only. The authors concluded that rational prescription of antibiotics in the OOH primary care service may be prompted in Denmark [3].

In a Swedish paper on management of patients with sore throat in relation to guidelines, rather curious results were presented. Of the 25 GPs who participated in this study nine followed clinical guidelines but 16 did not. All participating GPs admitted that they were aware of the guidelines. Nonetheless, an overwhelming majority of these GPs chose not to adhere to the guidelines. Of particular interest was the fact that all the GPs who did follow the clinical guidelines had discussed the guidelines at their primary care health centres. This possibly demonstrates a way to educate GPs on the importance of appropriate use of antibiotics [2].

The two studies have two completely different study designs. One was a qualitative study and the other had a quantitative design, both indicating a profound problem when it comes to antibiotic prescription. Undoubtedly, these studies are just a reflection on the situations in many other primary care settings in the Nordic countries.

Figure 1 shows that the use of antibiotics varies among the Nordic countries, Iceland showing the highest use.

Figure 1.

Prescription of antibiotics (J01 excluding Metenamin) in the Nordic countries 1978-2010, DDD/1000 inhabitants per day.

The concerns about the overuse and misuse of antibiotics have now been discussed by some of the world's leading politicians. In a recent WHO meeting in May held in Geneva, the German Chancellor Angela Merkel spoke about this global problem. She said:

What is important is to see to it that the effectiveness of the existing antibiotics is ensured and that we use them for purely medicinal purposes

Furthermore, Merkel emphasized that this is a global health problem and that all nations must work together to solve this problem of antibiotic-resistant bugs.

Some projects like the STRAMA network in Sweden provide a very good model that other countries can and probably will copy and use [4].

Another network against misuse of antibiotics is ReAct-Action on antibiotic resistance [5]. This organization is “aiming for profound change in awareness and action to manage the interacting social, political, ecological and technical forces that drive the rising rate of resistant human and animal infection and the rapid spread of resistance within and between communities and countries”.

The crucial points in the battle for correct use of antibiotics and the struggle against increasing antibiotic resistance is education. This education should be aimed at both the general public and health care professionals. The message must be stated loud and clear and repeatedly, over and over again. It seems that the prescribing habits in OOH are of particular concern and should be addressed with a special approach. Furthermore, GPs should be encouraged to use appropriate diagnostic tests before writing a prescription for antibiotics, for example a rapid strep test and perhaps measuring the level of C-reactive protein (CRP). Too much, too often, and inappropriate choice of a broad-spectrum antibiotic is simply bad medicine and as such not acceptable.

If left unattended and neglected, this problem could lead to an extremely difficult situation and we might face very serious implications with infectious diseases that today we can cure easily, but tomorrow will be a deadly battle for modern medicine.

GPs and all other doctors involved in prescribing antibiotics are cooperatively responsibly for future developments.

It is time to act.

Act now!