Some 4,000 Israelis of all ages die each year from infections that do not respond to antibiotics because their overuse has led to bacterial resistance, yet the Health Ministry has not explained to the public the danger of unnecessarily taking the medications, The Jerusalem Post has learned.
Eight years ago, the ministry established a unit for reducing resistance of bacteria to antibiotics in the hospitals, but its staff of eight doctors, nurses and computer experts never carried out public informational campaigns to discourage overuse of antibiotics.
Prof. Yehuda Carmeli, a former chief of epidemiology at Tel Aviv’s Sourasky Medical Center who established and heads the unit, agreed with the Post that such prevention efforts in the community “would have been advisable.”
The unit, located at Sourasky, never had an expert on public information and education on its team. Yair Amikam, the ministry’s former deputy director-general for information, who recently retired after 19 years in the position, did not run TV and radio campaigns against unnecessary use of antibiotics.
He was replaced on November 1 by ministry spokeswoman Einav Shimron-Greenbaum, who told the Post she is keen on funding and running public service campaigns to educate the public on this vital issue and others.
In the community, people who have a cold often pressure their family physician to give them antibiotics “to feel better,” even though colds are viral and pass by themselves, while antibiotics target only bacteria. Many health fund physicians do not routinely take throat cultures to determine within a day or so whether a sore throat was a viral or bacterial infection, Carmeli noted. It is common for doctors to give patients a prescription for antibiotics and tell them they can take the drug if their condition does not get better in a few days.
Carmeli conceded that “the ministry’s senior management has never sat down for a comprehensive look at this problem, including in the community. You are right,” he told the Post. For example, although pediatrics bodies have long advised not giving children antibiotics for ordinary ear infections that usually pass on their own, many pediatricians still give antibiotics for this when parents prefer to avoid a day or two of intermittent crying.
Carmeli was commenting on a just-released World Health Organization report on the serious and worsening problem of bacterial resistance to antibiotics. The WHO found in a new multi-country survey that many are confused about this major threat to public health and do not understand how to prevent it from growing.
Antibiotic resistance happens when bacteria change and become resistant to the antibiotics used to treat the infections they cause. Overuse and misuse of antibiotics increase the development of resistant bacteria, so when people really need the drugs for bacterial infections, the infections are not successfully treated – and patients die.
Almost two-thirds (64%) of some 10,000 people who were surveyed across 12 countries say they know antibiotic resistance is an issue that could affect them and their families – but how it affects them and what they can do to address it are not well understood. For example, most respondents erroneously believe antibiotics can be used to treat colds and flu, despite the fact that antibiotics have no impact on viruses. Close to a third (32%) of people surveyed believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment, yet this actually contributes to resistance.
“The rise of antibiotic resistance is a global health crisis, and governments now recognize it as one of the greatest challenges for public health today. It is reaching dangerously high levels in all parts of the world,” said WHO director- general Dr. Margaret Chan in presenting the survey findings.
“Antibiotic resistance is compromising our ability to treat infectious diseases and undermining many advances in medicine.”
“The findings of this survey point to the urgent need to improve understanding around antibiotic resistance,” declared Dr Keiji Fukuda, special representative of the director-general for antimicrobial resistance. “This campaign is just one of the ways we are working with governments, health authorities and other partners to reduce antibiotic resistance. One of the biggest health challenges of the 21st century will require global behavior change by individuals and societies.”
Among the common misconceptions revealed by the survey were that 76% of respondents think that antibiotic resistance happens when the body becomes resistant to antibiotics, but in fact, it is bacteria – not humans or animals – that become resistant to antibiotics. Nearly half (44%) of those surveyed think antibiotic resistance is a problem only for people who take antibiotics regularly; in fact, anyone, of any age, in any country can get an antibiotic- resistant infection. More than half (57%) of respondents feel there is not much they can do to stop antibiotic resistance, while nearly two-thirds (64%) believe medical experts will solve the problem before it becomes too serious.
Carmeli said that the rate of antibiotics usage here is twice that in the Netherlands and Scandinavia, where it is the lowest, but about two-thirds the rate in France, Belgium and Greece, where antibiotics use is very high. “It’s a cultural matter, and also lack of knowledge among doctors and the public. Some can stay home sick from work and not have to get a doctor’s note to the employer, so they don’t go to their physician for a cold.
But in other countries, like Israel, a note is required from the doctor, who is often pressured to give a prescription for pills.
Whether parents press the doctor for antibiotics when a child has an earache “depends on how long they can stand their child being miserable until the ailment goes away without the drugs,” Carmeli said.
The health funds do not give clear instructions to family doctors on when to test for bacteria, Carmeli conceded; his unit “is in touch only with the health fund management and not with individual doctors in the community. Two years ago, the ministry issued guidelines to the health funds on management of antibiotics, but these were widely ignored. Our unit’s job is not to disseminate information campaigns to the public. We spend time preventing bacterial infections in hospital departments, including premature baby and intensive care units, where they can be especially deadly.”
There is also abuse of antibiotic creams applied to skin infections, as well as abuse of antibiotics given to poultry and other animals raised for meat, but hospital infections are the most dangerous, the professor said. “Due to resistance, there are many types of antibiotics that are no longer effective in overcoming infections,” Carmeli said, and because they are very expensive to develop and not as profitable as other medications, the marketing of effective new antibiotics is becoming uncommon.