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Monday, June 22, 1998 Published at 23:41 GMT 00:41 UK


Fears over antibiotic policy

Bacteria are becoming resistant to drugs

The BBC's health correspondent Richard Hannaford reports on the findings
A huge difference in the use of antibiotics by European countries poses a major threat to health, according to new research.

The disparity in policy is making attempts to combat antibiotic resistance extremely difficult, it warns, raising the spectre of drug resistant bacteria for which no effective treatment can easily be found.

The new research follows a report by the House of Lords Science and Technology Committee earlier this year that warned the worldwide overuse and misuse of antibiotics would promote resistance among the bacteria which cause serious disease.

For the first time in 50 years, bacteria are appearing which are resistant to all existing antibiotics.

Defend themselves

[ image: Antibiotic resistance develops in hospitals]
Antibiotic resistance develops in hospitals
Experts believe this is because bacteria have frequent opportunities to become used to antibiotics and adapt to defend themselves.

In the survey, published in Pharmaceutical Times, UK practices on antibiotic use emerged as different from those of France, Germany, Italy and Spain in almost every aspect of hospital medicine and surgery.

The researchers, from IMS Health, warn that not even bringing all national policies to the level of the present best would combat the growing threat of antibiotic resistance.

Co-ordinated strategy unlikely

They found that individual clinicians' preferences, different patterns of illness, pressure of patient expectation and varying approaches to the funding of health care would make a co-ordinated, pan-European strategy very difficult to achieve.

For instance the use of antibiotics to combat post-operative infection is increasing in Italy and Spain, but in the UK the rate has declined.

In contrast combination therapy - such as the triple combination therapy for tuberculosis - is being used more frequently in the UK, but is in decline in Germany, Spain and Italy.

The theory of combination therapy is that bacteria have less chance to develop resistance if they are exposed to several different drugs. Experts also believe it is best to deliver drugs in short intensive bursts so that bacteria have less time to adjust.

UK is best

Overall, the research concludes, UK doctors are more aware than some of their European colleagues of the dangers of antibiotic resistance, and have amended their practices accordingly.

Despite this, resistance is still on the increase in the UK, albeit probably at a lower rate than other European countries.

The Head of the Antibiotic Reference Unit at the Public Health Laboratory Service, Dr David Livermore, said: "To argue that we have less to fear is a little like saying that a man driving towards a wall at 70mph is better off than one driving at 10mph.

"It is certainly true that he'll take longer to hit the wall and he does have a somewhat better chance of escaping - nevertheless his end is likely to be the same."

French excess

A separate report has found that French people are consuming more and more antibiotics whose use is too often "not justified" on medical grounds.

Sales of antibiotics have increased steadily over the past five years in France, on average by 2.1% a year in volume and by 2.6% in cost, according to government figures.

"No epidemiological reason, like an increase in the number of respiratory infections, can justify this rate of increase," the report said.

"Patients go to their doctors in France three times more often for tonsillitis and ten times more often for a cold than in Germany or Britain," the report added.

"Thirty-six percent of antibiotics are prescribed for viral infections, 40 percent for colds and 80 percent for acute bronchitis, which is not justified in most cases."

This kind of treatment was "not only unjustified and pointlessly expensive, but can lead to complications in individual people (unwanted side-effects) and more generally (with the development of strains of bacteria resistant to certain antibiotics)," the report said.

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