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Information for health professionals
Antibiotic resistance is an increasing public health threat all
over the world. To reduce this problem the use of antibiotics
has to be balanced, meaning that antibiotics should be used
only when they are needed and justiﬁed for therapeutic
reasons, and not otherwise.
Antibiotic resistance is causing increased illness and
preventable deaths, and the growth of infections from
resistant bacteria in health care settings is a major concern.
Every year in the European Union, Iceland and Norway,
an estimated 25 000 patients die from a serious resistant
bacterial infection, most of them in hospital. This number
covers only about half of the 53 Member States of the
WHO European Region: variable diagnostic capacity and
incomplete data in the rest of the Region mean that the
overall number is not known.
The increasing development of resistance is not only a threat
to the outcome of treating bacterial infections but a serious
risk to the success of some surgical interventions such as
colon surgery, transplants and hip replacements, as well as
many minimally invasive diagnostic interventions that take
place under antibiotic prophylaxis.
If you are a doctor, veterinarian, or dentist, and prescribe
drugs, you are responsible for using these life-saving drugs
wisely to cure patients, and thus keep antibiotics effective.
Overuse and misuse of antibiotics increase the risk of
resistant bacterial strains developing by selective pressure or
mutation. The transmission and spread of resistant bacteria
between people, food animals, products or the environment
can further contribute to the increased risk of antibiotic drug
failure, leading to severe disease, deaths and increased costs.
What doctors and dentists can do
Prescribe antibiotics only when needed and only as indicated by treatment protocols for the disease. Antibiotics do not cure viral infections – inﬂuenza, coughs and colds – and over-prescribing them inappropriately increases the emergence and possible spread of resistance.
Contribute to preventing infections
Do not sell antibiotics without prescriptions, nor in insufﬁcient
• All health care workers, particularly nurses, should promote
quantities to complete a course of treatment. Make sure that the
patient has full instructions on how they should be taken and for how long, and understands that the entire course must be
• Preventing infections is the key to the efﬁcient control of
resistant bacteria. In hospitals or clinics, this means a rigorous infection control programme.
• Establishing antibiotic and infection prevention committees in
Discuss the correct use of antibiotics with patients and make sure
health care settings allows better detection and reaction to
they take them according to the instructions, particularly ﬁnishing
hospital-acquired infections and effective treatment of them.
the course. Help to enforce rigorous infection control measures, to stop the spread of resistance.
• National recommendations from a national antimicrobial
resistance committee may give guidance for the prudent use
of antibiotics, whether in hospitals or outside.
The use of antibiotics as a growth promoter is already banned
• If you are involved in teaching, use the opportunity to speak
in the European Union and other countries should consider this.
about the prudent use of antibiotics and the dangers that lie
Use antibiotics wisely in the veterinary sector and avoid giving
antibiotics to healthy animals wherever possible.
What to say to patients
Some facts on antibiotic resistance
Many patients think they need an antibiotic to feel better, even
Ninety per cent of antibiotic prescriptions for people are issued
though they have a viral infection. This puts pressure on you. As a
at the primary care level and given for common infections such
health professional, it is important to talk about the illness with the
as urinary tract, respiratory tract or skin infections. Many upper
patient and discuss whether an antibiotic is the right treatment.
respiratory tract infections are not caused by bacteria and
antibiotics will not beneﬁt the patient.
Explain that antibiotics do not treat viruses and can make the patient more vulnerable.
Methicillin-resistant Staphylococcus aureus
(MRSA) often affects
• Recommend symptomatic relief and common practices
patients in hospitals and health care settings, leading to life-
for fever, inﬂuenza, runny noses, headaches and other
threatening situations, and in some countries over 25% of S.
symptoms that go hand in hand with common illnesses and
samples are resistant.
Evidence indicates that when low doses of antibiotics, such as
Tell patients what you ﬁnd on examination, such as clear
tetracycline, are used in healthy chickens as a growth promoter,
lungs or no signs of ear inﬂammation, to allay some of their
this quickly (within 36 hours) leads to the excretion of resistant
, a common bacterial cause of infections in
• Explain your diagnosis and how common infections develop
and usually improve within 72 hours. Give advice on how to recognize more severe symptoms.
Of the 440 000 estimated multidrug-resistant tuberculosis (MDR-TB) patients per year in the world, 81 000 are estimated to be in
If you do prescribe antibiotics
the WHO European Region (20% of the global burden).
• Follow national treatment protocols if they exist to ensure
Points to remember
the appropriate treatment regimen and dose to prevent the
Antibiotic resistance could take us back to the pre-antibiotic
era. Resistant disease-causing bacteria (or genes that induce
• Make sure the patient understands the importance of
resistance) are emerging and can spread rapidly between people,
following the prescription exactly, and completing the
animals, products and the environment. Currently, very few new
antibiotics are in the development pipeline.
• If dealing with life-threatening infections in hospital, the use
Antibiotic resistance increases health care costs. If illnesses
of antibiotic drugs should ideally be based on culture results.
last longer and treatment is more complex, costs rise. This also
• Remember that for certain medical and surgical
places a heavier ﬁnancial burden on families and societies. The
interventions, bacterial prophylaxis with antibiotics can in
European Centre for Disease Prevention and Control estimates
that resistant bacterial infections cost European Union countries
Veterinarians should not prescribe antibiotics as promoters of animal growth. Only use antibiotics when needed.
Deﬁnitions: antibiotics and antibiotic resistance
Antibiotics are a subclass of antimicrobial agents that are active
only against bacteria. They can either be naturally derived from
bacteria or moulds (fungi) or produced synthetically. Scientiﬁcally,
“antibiotic” refers only to naturally produced antimicrobial
agents, but this text uses the term to mean all drugs or agents
against bacterial infections.
The emergence of resistance to antibiotics is a natural biological phenomenon that occurs when antibiotics are used. Antibiotic resistance results from the ability of bacteria to withstand attack by antibiotics, which can develop either through mutation or by acquiring resistance genes from other bacteria that are already resistant.
The main drivers of antibiotic resistance are the use of antibiotics, especially overuse (but also misuse and underuse) and the transmission and spread of already resistant bacterial strains or genes that carry the information on resistance.
For more information, see the web site of the WHO Regional Ofﬁce for Europe http://www.euro.who.int/whd2011.
For further information on antibiotic
For further information and
resistance, please contact:
interview requests, please contact:
Senior Adviser, Antimicrobial Resistance,
Scherﬁgsvej 8, DK-2100 Copenhagen Ø, Denmark
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