Malta, where up to 35 people could die every year from a bacterial infection, has one of the highest economic burdens of antimicrobial resistance in Europe, a consultation meeting heard.

More than €3 million is spent every year on infections caused by Antimicrobial Resistance (AMR), according to the Organisation for Economic Co-operation and Development (OECD). If this trends continues, the cost could more than double over the next decade.

However, if preventive measures were taken, the expenditure could be slashed, according to Michael Borg, chair of the National Antibiotic Committee. 

Read: Fewer Maltese take antibiotics, but use is still high

Resistant bacterial infections develop rapidly, and what was once considered a superbug, MRSA, nowadays “pales” against an increasingly prevalent super-bug known as CRE. 

At times, the only treatment that works on CRE is Colistin, a last resort antibiotic for life-threatening infections, whose side effects could include damage to the patient’s kidneys.

CRE is an increasing challenge across Europe, however Malta has one of the highest levels, alongside Italy, Greece, Turkey and Cyprus, Prof. Borg noted.

He was speaking at a meeting with stakeholders, including healthcare and veterinary professionals, as part of the consultation process on a national strategy addressing AMR in Malta. Concern about antibiotic use among farm animals, especially over the counter treatment, was prevalent throughout the meeting.

Read: Two out of every five who take antibiotics do not need them

Addressing the same consultation session, Superintendent of Public Health Charmaine Gauci said that resistance to antibiotics was part of the natural process, however, misuse and overuse accelerated the challenge.

If preventative measures were taken, the expenditure could be slashed

According to Eurobarometer data, 14% of the Maltese use antibiotics for sore throats and a further 12% to ‘treat’ the flu. In such viral infections, antibiotics are always ineffective, risking increasing resistance to particular bacteria in the patient himself, or those around him, which could subsequently lead to death.

Sadly, 33,000 people die every year in the EU and EEA area because of an infection that cannot be treated, European Centre for Disease and Prevention Control data shows.

Read: Despite resistance, the future looks good for antibiotics

Martin Seychell from the European Commission, told stakeholders that the EU had a “one health approach to AMR”, as this was not just a human health issue, but also an animal and environmental one. 

The EU was investing in research on timely diagnosis, new classes of antibiotics, the use of vaccines as preventive treatment and infection prevention through other means.

Referring to Malta, he said the island was paying a high price for resistance, with the OECD figures on mortality and the annual cost of AMR placing Malta at the top of the list, following Italy, Greece, Portugal, US, France, Cyprus and Slovakia.

Why is there high use of antibiotics in the community and at hospitals?

Malta has the second highest European consumption of antibiotics in the community, following Italy, with 42% of the population taking at least one course of antibiotics in a year. 

However, almost half of those taking antibiotics do so to ‘treat’ the flu, colds and sore throats. 

Data shows that 96% of antibiotics are prescribed by medical doctors, but Prof. Borg believes that Malta has some of the best medical doctors in Europe. One of the main drivers of excessive prescription of antibiotics, he said, was a ‘better safe than sorry’ culture, also known as uncertainty avoidance. 

Still, with 92% of the Maltese population being aware that unnecessary use of antibiotics will make them ineffective, culture could be changed, he added.

Draft proposals of the national strategy action plan that will kick off this year

■ Enhance knowledge and awareness on AMR among healthcare and veterinary professionals by ensuring availability of continuing professional education activities on AMR and prudent use of antibiotics, not sponsored by the industry.

■ Strengthen surveillance system of antibiotic resistance especially in primary care and veterinary practice.

■ Introduce electronic systems that include antimicrobial prescribing and link them to clinical indication and consumption data.

■ Develop a system for safe disposal of antibiotics in the community.

■ Fast track the procurement of new antibiotics effective against currently resistant organisms.