There was a significant drop in antibiotic use in Malta during the first year of the pandemic, new analysis has found.

European Union figures show an almost 20% drop in overall consumption of antibiotics in Malta during 2020, compared with the previous year.

It was a larger drop than the EU average of more than 15%.

The European Centre of Disease Prevention and Control noted that the decrease “had a more noticeable effect in countries where overuse and inappropriate use was common before the COVID-19 pandemic”.

It said that the drop in use was mostly in the community sector. Malta was one of seven countries that reported a decrease in prescriptions in the community – that is, by family doctors – alongside an increase in the hospital sector.

There has been a drive across the EU to reduce the number of unnecessary prescriptions to try to tackle the growing threat of antibiotic resistance. 

When last-line antibiotics are no longer effective, only limited treatment options remain and these may not work in every situation, sometimes leading to fatal outcomes. 

The “large” decline in antibiotic consumption in the European Union has been put down to a drop in the number of primary care consultations, either because of hesitancy to seek healthcare for mild, self-limiting infections or difficulty in obtaining an appointment for a consultation, the EU agency said.

Anthony Azzopardi, president of the Association of Private Family Doctors, said his own prescriptions for antibiotics have been “few and far between” due to a reduction in respiratory tract and chest infections. 

He echoed some of the reasons listed by the ECDC, as well as a drive to stop taking antibiotics unnecessarily.

Apart from COVID-19 measures, including less person-to-person transmission, he also mentioned the fact that children were out of school last year, meaning the biggest transmitter of sickness was eliminated.

Azzopardi said the decrease was also evidenced by the fact that pharmacies were not selling the antibiotics they had in stock.

In 2020, the mean total consumption of antibacterials for systemic use (community and hospital sectors combined) in the EU was 16.4 DDD (defined daily dose) per 1,000 inhabitants per day, down from 19.9 DDD the previous year.

In Malta, the drop was from 20.7 DDD to 16.6 DDD. 

The decline was also attributed to the reported low incidence of non-COVID-19-related respiratory tract infections in the community in EU countries in 2020, a likely consequence of the many non-pharmaceutical interventions, such as physical distancing, lockdowns, respiratory etiquette, use of face masks and promotion of hand hygiene, all measures put in place in response to the pandemic.

Among the 27 member countries, penicillins were the most frequently used antibacterials, according to the data.

Despite the pandemic-induced decline, however, the ECDC pointed out that anti-microbial resistance (AMR) levels remained high for several important combinations of bacterial species and antimicrobial groups, with the highest percentages generally reported by countries in the south and east of Europe.

“Although a decrease in antibiotic consumption has been seen in these countries, preliminary findings from the eastern part of the World Health Organisation European Region and Central Asia indicate that,  over time, antibiotic use rose,” Hans Henri P. Kluge, WHO regional director for Europe, said.

“We know that access to antibiotics is a great concern, over-the-counter sales still occur in parts of the European region and the antibiotics available are often associated with the highest risk of developing resistance.”

An increase in public health response is a must and action is being stepped up to make the fight against AMR a priority, Stella Kyriakides, European Commissioner for Health and Food Safety, said.

“Antimicrobial resistance remains a serious challenge globally,” Kyriakides said, describing it as “a silent pandemic that is happening here and now”.

Resistance to these also compromises the effectiveness of life-saving medical interventions such as organ transplantation. 

The ECDC estimates that, each year, more than 670,000 infections occur in the European Union due to bacterial resistance to antibiotics and that approximately 33,000 people die as a direct consequence, with the health burden being comparable to that of influenza, tuberculosis and HIV/AIDS combined.

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