Can the Covid-19 pandemic be a turning point for antibiotic resistance?
The use of antibiotics is plummeting in Norway during strict corona measures.
The use of antibiotics is plummeting in Norway, shown by figures from the Norwegian Pharmacy Association. Sales of antibiotics have been lowest during the periods when people had to stay at home this spring. In April and May, consumption fell by as much as 25 per cent, before rising again this summer.
Unnecessary use of antibiotics leads to the development and spread of resistant bacteria. Can the corona crisis teach us to reduce the use of antibiotics?
A larger health crisis than corona
Antibiotic resistance may pose a larger health crisis than corona. For resistant bacteria, there are no vaccines, nor immunity. Should the antibiotics stop working, common infections will be far more difficult to treat.
And resistant bacteria are on the rise: Worldwide, 700,000 people now die from resistant bacteria every year. It is estimated that the number of deaths could increase to 10 million a year by 2050 (The Review on Antimicrobial Resistance, 2014).
Operations, transplants and cancer treatments can become far more risky to perform. Much of our modern and advanced medicine depends on antibiotics to be effective.
Why do resistant bacteria occur?
The main explanation for the occurrence of resistant bacteria is the unnecessary use of antibiotics.
Worldwide, more than half of the antibiotics in primary health care are used to treat mild respiratory infections, such as sore throat, ear infection and sinusitis. These infections can often be treated without antibiotics.
For example, ear infections will usually get better on their own within three or four days. Nasal drops and painkillers are the best medicines.
A sore throat is uncomfortable, but if you are otherwise healthy, your body will often be able to treat the infection on its own. In such cases, healthcare professionals are advised to await the disease before prescribing antibiotics.
Nevertheless, doctors still dispense too many antibiotics, often because they feel that patients demands them.
Norway not best in class
Norwegian doctors are reluctant to prescribe antibiotics – but we are not the best in class. Before the corona pandemic, Norwegian doctors prescribed significantly more antibiotics than their Swedish counterparts, and up to 30 per cent more than their counterparts in the Netherlands.
It has been a stated goal to reduce the use of antibiotics in Norway, preferably down to the level of the Netherlands. However, from 2018 to 2019, use in the primary health care service increased again by 2 per cent.
The sharp fall in antibiotics used this spring nevertheless shows that it is possible to cut use further – also in Norway. Less infections, as an effect of the strict infection control measures, may be one explanation for the sharp fall. Another explanation is that fewer people consult their doctor for mild respiratory infections.
Affects bacterial flora in the intestine
We recognize this from previous studies done in Norway: A survey from 2018 showed that more antibiotics are used in areas where people often consult their general practitioner. Similarly, the use of antibiotics is lower in areas where people tend to use their general practitioner less – regardless of how ill they are.
The benefits of reducing the use of antibiotics are many. Not only do we reduce the number of resistant bacteria. Unnecessary use of antibiotics is also not good for our health. Antibiotics affect our normal flora, i.e. the good bacteria we have in the gut. Killing these bacteria can weaken the immune system short term.
A few years ago, a group of British researchers (Little P. et al., 1997) examined several hundred patients who had all turned to the primary health care service with mild respiratory infections and sore throats. The researchers compared the relapse rate for those who had been prescribed antibiotics by their doctor, with the relapse rate for those who had not. In fact, they found that the recurrence rate was higher for those who were prescribed antibiotics.
More of those who had used medication to recover thus became ill again. The proportion of other complications in those who did not take antibiotics were not found to be any higher than in those who took antibiotics.
Must be used wisely
Although too many antibiotics are still prescribed in Norway, it must be emphasized that Norwegian doctors are better than many of their European colleagues. French doctors, for example, prescribe twice as many antibiotics.
The Antibiotic Centre for Primary Care in Norway is actively working to reduce unnecessary use of antibiotics. The Centre conducts comprehensive quality improvement courses in antibiotic treatment. These courses have been very popular among GPs and seems to have an effect.
The use of antibiotics is far lower than it was 10 years ago. But more can still be done.
Cutting unnecessary use of antibiotics is crucial to reduce the spread of resistant bacteria, and it is also beneficial for our individual health. It is important to preserve antibiotics for those who really need them.
The health service is completely dependent on antibiotics, and resistant bacteria make the job far more difficult. Therefore, we must take care of each other, not only in time of corona, but also after.
Antibiotics should be used wisely. Listen to your doctor and do not use antibiotics unless you really need to.
This opinion was first published in the Norwegian national newspaper Aftenposten.