Spain is among the countries that reduce antibiotic consumption the most

Spain is among the countries that have reduced the use of antibiotics the most, with a fall of 6.7% compared with 2.5% for the European Union as a whole between 2019 and 2022, although it has the seventh highest use of these drugs . In particular, the European average in 2022, the latest available data, was 19.4 prescribed daily doses per thousand inhabitants per day (DHD), while in Spain it reached 23.2 DHD. This is one of the findings of the report, A Panorama of Microbial Resistance and New Antibiotics, which was prepared by the General Council of Colleges of Pharmacy to coincide with the celebration of European Day for the Wise Use of Antibiotics next Monday, 18 November. Antibiotics.

The document provides an in-depth analysis of the current situation with microbial resistance and the availability of new antibiotics. A problem on which progress has been made, as evidenced by the reduction in consumption rates since the implementation of the National Plan to Combat Antibiotic Resistance (PRAN), but which, despite all these efforts, continues to be one of the greatest threats to global public health in the world. 21st century.

In this scenario, the development of new antibiotics is not yet sufficient to compensate for the increasing emergence of resistance. Over the past five years – since January 1, 2020 – only five new antibiotics have been registered in Spain – oritavancin, delafloxacin, cefiderocol and the combinations of meropenem/vaborbactam and imipenem/cilastatin/relebactam – out of the last seven approved in the EU, which also includes lefamulin and cefepime/enmetazobactam.

Among the strategies to avoid the problem of antimicrobial resistance, we must emphasize the importance of vaccination and innovative pharmacotherapeutic approaches, for example using monoclonal antibodies or phage therapy, a therapeutic approach that uses bacteriophages, that is, viruses that infect and destroy bacteria, to treatment of bacterial infections.

Regarding vaccines, the report emphasizes that they are another fundamental element in the fight against infectious diseases, going well beyond their primary function of individual prevention, as they also contribute to herd immunity by reducing the transmission of pathogens within a community.

Moreover, beyond the health aspect, vaccines are an extremely cost-effective strategy. A recent study in Spain estimates that each euro invested in the Common Vaccination Schedule amounts to between €2.91 and €4.58, with a total economic benefit of around €800 million.

The role of the pharmacist

From research to dispensing to optimization of use, the pharmacist has a clear responsibility and opportunity to act in the fight against antimicrobial resistance. Rita de la Plaza, Treasurer of the General Council and Director of the journal Panorama Actual del Medicamento (PAM), in which this review will be published, emphasizes that “pharmacists are in a privileged position to directly influence the correct use and monitoring of antibiotics.” treatment methods. This role extends beyond drug dispensing to aspects such as public health education, participation in multidisciplinary medical teams, or innovation in the development of new antibiotics.”

One of the fundamental roles of pharmacists in the development of professional pharmaceutical care services is health education. In this sense, the community pharmacy is a medical institution of particular importance, which offers a number of basic recommendations for the dispensing of antibiotics, among others:

• Referral to a doctor when encountering a symptom indicating an infectious disease. They warn about the dangers of self-diagnosis, which can lead to erroneous self-medication.
• Refusal to issue a permit antibiotic without appropriate medical prescription, both for legal and medical reasons.
• Insist populations with many common microbial illnesses, such as influenza or colds, They are produced not by bacteria, but by viruses. or, in any case, by microorganisms other than bacteria and therefore the use of antibiotics is completely useless and also promotes the release and proliferation of bacteria resistant to the incorrectly used antibiotic.
• Advise that using leftovers from previous antibiotic treatment poses a serious health risk.both due to their improper use and the possibility of their damage (expiration or damage as a result of storage in inappropriate conditions). Therefore, such remains must be taken to a pharmacy so that they can be collected at CIGRE points under appropriate environmental conditions.
• Insist on the need to complete full treatment.even if symptoms improve sooner. If treatment is stopped early, there is a risk that the pathogenic bacteria will multiply again and develop mechanisms of resistance to the antibiotic being used, thereby causing a potentially more serious infection and facilitating the spread of resistant strains.
• Remember that antibiotics are generally safe drugs. although, like any medicine, may cause adverse effects in some cases:
  • Allergy to certain antibiotics (especially beta-lactams) is one of the most well-known and common side effects; Therefore, the patient must be informed if he has an allergy.
  • If diarrhea persists for more than two days in a row during or immediately after antibiotic treatment, it is advisable to consult a doctor.

Recommendations

As noted, the role of the pharmacist is fundamental in the fight against microbial resistance. For all these reasons, the European Pharmaceutical Group has called for the implementation of a number of public policies at European level to strengthen the role of pharmacy in the face of antimicrobial resistance (Attached table).

Public policy recommendations for combating antibiotic resistance

Pharmacist’s job	Expand pharmaceutical care services to support referral, prescribing, stewardship and decontinuation of antibiotics, thereby ensuring patients are adequately supported in the fight against antimicrobial resistance at the primary health care level.
	Support the development of pharmacist work by providing adequate remuneration for medical services in identifying microbial infections.
	Develop new health services and protocols to address common problems while avoiding unnecessary visits to primary care or urgent care.
	Expand vaccination services in pharmacies.
	Strengthen student education, training, and continuing education on antimicrobial resistance.
	Implement, review and maintain infection prevention and control measures in pharmacies.
	Ensure adequate funding for waste management and sample collection plans, if implemented.
Preventing and addressing antibiotic shortages	Endorse national measures to give pharmacists greater flexibility to find alternatives when a medicine is not available.
	Guaranteed supply of existing antimicrobial drugs.
	Combating the sale of antimicrobials outside the EU.
Recipe and packaging	Promote changes in legislation and clinical practice to ensure that indications are always included in prescriptions.
	Simplify and harmonize the prescribing and dispensing of antimicrobials in containers appropriate to the duration of treatment.
	Promote the prudent use of antimicrobials through community pharmacy campaigns.
Communication	Introduce the use of electronic medical records.
	Introduce antibiotic prescribing and dispensing via electronic prescriptions at EU level to facilitate the collection of data on antibiotic prescribing and dispensing.
	Continue to engage and support community pharmacists in implementing action plans to combat antimicrobial resistance.
	Increase collaboration and collaboration between community pharmacists and prescribers, as well as other healthcare professionals, regulators, industry, patients and the public in the fight against antimicrobial resistance.
Innovation	Create new business models/incentives that encourage the development of new antibiotics.