Antibiotic eating European monkeys
Bonjourrrr, ya antibiotic eating surrender monkeys!
No doctor likes to think that they are the one who is giving out all these antibiotics to viral illnesses. There is always someone else at fault. Partners blame locums. Locums blame nurses. Everyone blames the patients. Me? I blame the French. They have shamelessly flung antibiotics around for years with Gallic abandon. According to a PLOS paper more than 70 prescriptions per 100 inhabitants were issued for antibiotics in 15 regions in France in the winter of 2000. Sacre bleu.
However, it seems that the French have been making a big effort with a nationwide campaign over the period 2002-07. ‘Les Antibiotiques c’est pas automatique’ was a massive push to educate the public and to support doctors to say ‘non’. The researchers report that the use of all major antibiotic classes, except quinolones, decreased in all 22 regions of France by around 27% (95% CI 20 to 34%) over the same period. Of course, as we all know, association is not causation and there could be other reasons that have contributed to the reduction.
The BMJ also reported this week on European variations in prescribing for acute cough. There were some huge variations in antibiotic prescribing with the worst culprits being the Slovakians who prescribed on 90% of occasions. The Spanish were the lowest at 20% but given that antibiotics are available OTC this may not be a wholly reliable indicator. The Welsh and English were high prescribers with rates of 70% and 63% respectively. The crucial news from this prospective study is: there was no difference in outcome between the lowest rates of prescribing and the highest. This screams out to almost everyone that we are over-prescribing antibiotics across Europe. The French were not one of the 13 countries involved but it looks a bit like GPs in glasshouses shouldn’t throw stones.
Public health is a slowburn. There aren’t many that go into medical school with the fiery passion of John Snow for epidemiology burning in their breast. For more of them it is the chest-cracking and heart thumping that fires them up. Preserving antibiotics will almost certainly save lives in the future but you won’t get any credit for it now. There is a significant problem with multi-resistance pneumococcal pneumonia but someone getting pneumonia that responds to penicillin will quietly go home. Where’s the drama in that? We are oblivious to the fine line that separates us from the horrors of the pre-antibiotic age. As has been said: public health isn’t seen when it’s done right.
It’s a slow job. A million tiny incremental steps working toward a global reduction in antibiotic use that could have real significance for all our health. We can all keep chipping away but the results of the French campaign, while encouraging, were not spectacular. Is it enough? Perhaps we should look to a future where public health policy becomes more draconian to curtail our continued profligacy with antibiotics.
Sabuncu, E., David, J., Bernède-Bauduin, C., Pépin, S., Leroy, M., Boëlle, P., Watier, L., & Guillemot, D. (2009). Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007 PLoS Medicine, 6 (6) DOI: 10.1371/journal.pmed.1000084
Butler, C., Hood, K., Verheij, T., Little, P., Melbye, H., Nuttall, J., Kelly, M., Molstad, S., Godycki-Cwirko, M., Almirall, J., Torres, A., Gillespie, D., Rautakorpi, U., Coenen, S., & Goossens, H. (2009). Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries BMJ, 338 (jun23 2) DOI: 10.1136/bmj.b2242
