TUESDAY MORNING in a busy GP surgery and Mrs Murphy comes in the door.
GP: “Good morning, Mrs Murphy, how can I help you today?”
Mrs Murphy: “It’s this cough. I had a bad cold last week and it seems to have gone to my chest. I’m ready for the antibiotics at this stage.”
GP: “Everything seems to be fine there. We’ll keep an eye on things for now and come back in a week if your cough doesn’t improve.”
Mrs Murphy: “I really want the antibiotics to be on the safe side.”
GP sighs and takes out his prescription pad: “Okay, but I don’t think they will do any good.”
If the new HSE campaign telling us that antibiotics are wasted on colds and flu is to be believed, this scenario plays out in GP surgeries every day. The campaign website says, “Antibiotics are sometimes taken unnecessarily for infections . . . where they have absolutely no benefit for the individual.”
Hang on a minute: in Ireland nobody can “take” antibiotics unless they are prescribed by a doctor, in which case the sentence should read, “Antibiotics are prescribed unnecessarily . . .”
The campaign exhorts people not to ask their doctors for antibiotics for themselves or their children. This implies patients are demanding antibiotics in situations where they will have no effect and that doctors are unable to say no. There is no evidence of this, and prescribing practices are more likely to be related to habit and time constraints.
There is a global problem with misuse, abuse and overuse of antibiotics. The World Health Organisation calls this problem “a public health emergency of yet unknown proportions” and estimates that 25,000 people die in the EU every year because of infections from antibiotic-resistant bacteria. A 2011 report from the Health Protection Surveillance Centre says three-quarters of antibiotic usage is of questionable therapeutic value.
The HSE campaign puts the onus on the patient to reduce antibiotic use. The same onus is not put on the doctor to say no.
Since the publication of A Strategy for the Control of Antimicrobial Resistance in Irelandin 2001, there has been little change in the prescribing practices of Irish doctors. The rate of antibiotic consumption in Ireland is medium to high compared with other countries. Switzerland and Russia have rates about half that of Ireland. The HSE Service Plan performance report for September 2011 shows a 7.4 per cent increase in GMS prescriptions and a 6 per cent rise in antibiotic consumption rates in hospitals.
It is interesting that these reports use the word consumption as if people are voluntarily choosing to consume antibiotics. We do not have an antibiotic consumption problem in Ireland, we have a prescribing problem, so why is the HSE campaign directed at the public?
The use of antibiotics in food production in Ireland is much more highly regulated than their use in humans. The National Residue Plan Report 2010, from the Department of Agriculture, Food and the Marine, shows that levels of antibiotic residues in Irish-produced meat, fish and other foods are at low levels, "far below the levels where the residues pose a risk to [human] health".
In 2010, antibiotic residues were found in only 0.1 per cent of samples. While it’s good to know our food is safe, one wonders why the same strict rules cannot be applied to the use of antibiotics in humans. One of the reasons is that farmers are penalised. Positive results for antibiotic residues lead to investigation and a penalty to the farmer’s single payment.
There is no investigation and no penalties for doctors or hospitals when antibiotics are misused and overprescribed for humans. This is a remarkable situation. Instead of effective public policies we get a campaign directed at people who have no control over prescribing antibiotics.
An excellent booklet, Guidelines for Antimicrobial Prescribing in Primary Care in Ireland, available on the HSE website, explains the correct treatment for coughs, colds, earache and other common ailments. Read it before you attend your GP and check that he or she is treating your problem in accordance with recommended guidelines. If not, ask questions.
Interestingly, reducing the need for antibiotics in humans is exactly the same as for animals. Stay healthy by eating safe food and living in a good environment, prevent disease with vaccines, and be hygienic.
Have a healthy winter.
Dr Jacky Jones is a former regional manager of health promotion with the HSE