Myths about antibiotics are a much bigger problem than you think

Each year, antimicrobial resistance (AMR) affects millions of people across the globe. In 2019 approx. 4.95 million deaths were associated with AMR, a 2022 systematic analysis reported. New tools and methods are needed in the global fight against AMR.

The University of Copenhagen (UCPH) is collaborating with a large consortium of European partners to fight AMR by reducing the overuse of antibiotics in human health. The HAPPY PATIENT project focuses on reducing the use of antibiotics in four healthcare sectors (primary care, out-of-hours services, nursing homes, and pharmacies) across five target countries, by educating both healthcare professionals and patients on AMR and the use of antibiotics. The role of the UCPH is to develop educational materials for patients that will facilitate the discussion about antibiotics between the patient and the healthcare professional.

Common misconceptions about the use of antibiotics

Starting in January 2021, a team of UCPH researchers developed a study to identify the most common misconceptions and knowledge gaps of both healthcare professionals and the patients that can lead to the overuse of antibiotics and should be addressed in the intervention of the HAPPY PATIENT project. The researchers invited a multinational and interdisciplinary panel of “experts” to participate in a Delphi consensus study. Here, they had to identify a number of misconceptions and knowledge gaps about AMR, the use of antibiotics in general, and the use of antibiotics for some common community-acquired infections, such as respiratory and urinary tract infections.

Some of the misconceptions of the patients that the panel of experts deemed important to address in the patient educational tools include basic facts about AMR and antibiotics. For example, the experts almost unanimously agreed that we need to educate patients that antibiotics are not effective against viral infections and that having a cough or a fever does not necessarily mean that they need to be treated with antibiotics. Further, the experts discussed and agreed that sharing antibiotics among family and friends, or using leftover antibiotics without consulting a healthcare professional first, is still a huge problem that leads to misuse of antibiotics and needs to be addressed in the intervention material.

There are currently several factors identified for the over-prescription and overuse of antibiotics in the healthcare sector. These include perceptions of antibiotics among healthcare professionals and patients, expectations of antibiotics from the side of the patient, and fear of under-treatment and withholding care from a patient who needs it, among others. Lack of knowledge about the problem of AMR and widespread misconceptions about antibiotics within the general public can lead to patients demanding antibiotics from their healthcare providers, which leads to misuse of antibiotics. Therefore, it is important to address those knowledge gaps and myths by educating the patients about AMR, the use of antibiotics, and their infection, and empowering them to make informed decisions regarding their health.

The patient educational material developed with the help of the UCPH study will be translated into the local languages of the countries where the intervention will take place (Greece, Spain, Lithuania, Poland, and France), and will be distributed to the clinics and healthcare providers that will participate in the HAPPY PATIENT intervention, starting in November 2022. The intervention will also include a refresher training for the healthcare professionals about how to diagnose and manage common community-acquired infections, national guidelines for the use of antimicrobials, and workshops on how to enhance their communication skills when interacting with patients. Lastly, the healthcare professionals will be given the opportunity to reflect on their own practice and prescribing style based on their personal audit results and identify areas where they can reduce the prescribing of antibiotics into their own practice.

A short history of antibiotics and antimicrobial resistance

The life-saving power of antibiotics has been known for thousands of years, as earlier forms of these compounds were used in ancient civilizations to treat infected wounds. However, it was not until the 20^th century that scientists discovered the antibacterial effect of antibiotics, which marked the beginning of the antibiotic era. The discovery of penicillin by Alexander Fleming in 1928 changed the course of history by saving thousands of lives during WWII. Since then, multiple classes of antibiotics have been discovered and have successfully treated bacterial infections. However, very soon after the discovery and wide use of antibiotics, the first signs of resistance became apparent, which once again made infections hard to treat. The first human trials of penicillin took place in the beginning of the 1940s, and already by 1942, there was a documented spread of penicillin-resistant Staphylococcus aureus strains in hospital patients. Since the discovery of penicillin, more than 150 antibiotics have been found, and for the majority of them, resistance has emerged. 

One of the biggest public health threats today

A return to the pre-antibiotic era is one of the biggest public health threats facing humanity. Especially alarming is the rapid spread of multi-drug resistant bacteria – the so-called “superbugs” – that cause infections that no longer respond to any of the existing antibiotic treatments and can lead to death. Currently, AMR each year affects millions of people across the globe. A 2022 systematic analysis reporting the global burden of AMR, estimated that only in 2019 about 4.95 million deaths were associated with AMR, out of which about 1.27 million deaths were directly attributable to resistance. In the EU region, AMR is a widespread problem; however, the situation across the region varies with higher levels of AMR in the southern and eastern parts of Europe. Even though it has been documented that misuse and overuse of antibiotics are the main drivers of AMR, antibiotics are still overprescribed worldwide.