Super bugs

More antibiotics, more resistant germs

In some southern European countries, doctors prescribe three times as many antibiotics as in Northern Europe. There is no medical explanation for these dramatic differences within the EU. However, high consumption levels can be highly dangerous: because where many antibiotics are taken, resistant germs are more frequent, as recent data from the EU authority on infectious diseases shows.

von Hristio Boytchev

© Ivo Mayr

A Greek person swallowed more than three times as many antibiotics as a Dutchman last year. This is what the European Centre for Disease Prevention and Control (ECDC), the EU’s top infection control authority, has found. In one day, 36 out of 1,000 people received antibiotics in Greece – the highest rate in Europe. In Holland, on the other hand, the number was only 10.7 out of 1,000 people.

In other places one sees a clear north-south dividing gradient. The doctors in Romania, Cyprus, France, Belgium and Italy prescribe antibiotics more often. In comparison, the consumption in Estonia, Sweden, Latvia and Austria is low. Germany ranks sixth in the EU – with 14.4 daily doses of antibiotics per 1,000 inhabitants. This is a comparatively good value.

The question of how often people swallow antibiotics is important. The more antibiotics are prescribed, the more frequently resistant germs develop, a trend which can also be seen in the ECDC data.

But why are antibiotics used so much more frequently in the southern countries? The hospital hygienist Walter Popp sees for the poorer health care in southern countries as responsible for the higher consumption. There are problems with hygiene, which is why infections occur more frequently, which in turn means that more antibiotics are consumed.

In addition, the more people know about antibiotics, the more reluctant they deal with the drug. This was the result of the “Eurobarometer”, a recurring pan-European opinion poll commissioned by the EU Commission. The citizens were asked whether they believe that antibiotics help with a cold.

In Greece, Bulgaria and Poland, only 30% knew that antibiotics were of no use in a cold. In Finland, Holland and Sweden, on the other hand, it was about 80 per cent of the population. Germany is close to the European average of ignorance at 57 percent. This means that around every second respondent would consider an antibiotic useful for coughing and a running nose. And whoever believes in an effect, asks his doctor for the drug and often gets it prescribed

Overall, the best knowledge about the effects of antibiotics was shown by the citizens of Finland, Holland and Sweden – all countries with low consumption. The Greeks and Italians, on the other hand, were the least informed about the benefits and harm of antibiotics.

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In many countries, people can get antibiotics without a prescription at the pharmacy. For example, even though this is not allowed in Greece, the pharmacies do not adhere to he rule. Here about 20 percent of the antibiotics are taken without the patient having previously seen a doctor. In Romania, the number is16 percent. On the other end of the spectrum: Sweden, there it was only two percent.

Also in animal production there is an extreme north-south gradient. At the top is Cyprus with almost 400 milligrams of antibiotic consumed for each kilo of farmed animal, followed by Italy with 341 milligrams. This has been calculated by a comprehensive study by ECDC last year. Germany is around 200 milligrams – close to the European average. Again, the Scandinavian countries are particularly economical: Finland consumes 24, Sweden 13, Iceland 6 and Norway only 4 milligrams per kilo live weight animal — about a hundred times less than Cyprus.

As far as the total consumption of antibiotics is concerned, Italy is at the top of the list: 1400 tonnes of antibiotics were used in animal husbandry, shortly thereafter: Germany with 1300 tonnes. The figures are from 2014, the most recent year that has been evaluated. A few years ago, Germany was still the leader in animal antibiotics, but since then the farms have significantly reduced their consumption.

On the other hand, when it comes to human consumpion, according to the ECDC study conducted in 2015, France was the top performer with 720 tonnes, followed by Italy and Spain.

In total, 3400 tonnes of antibiotics were used in human medicine in the 26 countries studied, and more than twice as much, about 8,000 tonnes, in animal breeding.

The massive use of antibiotics in the animal mast is problematic for humans, as is shown by the ECDC study. Because individual germs, which develop resistances in animals, can sometimes also affect humans. Or their genetic material can be transferred to human pathogens.

The ECDC study also demonstrates the link between antibiotic use and resistance formation in other respects: if a lot of antibiotics are consumed in a particular country, there is also more resistance to this antibiotic.