Scientists are sounding the alarm about the public health risk posed by Greece’s sad first place in the abuse of antibiotics and stress: No antibiotics for colds or toothaches, not at home, no pressure on our doctor. Antibiotics are neither vitamins nor painkillers!

The research data presented at a press conference organized by the Medical Association of Athens, the Hellenic Intermunicipal Network of Healthy Cities of the P.O.Y and the Hellenic Society of Chemotherapy, on the occasion of the World Week for Information and Awareness of Microbial Resistance on antibiotics (November 18-24, 2023), it’s another disappointing year.

This initiative is part of the ISA’s multi-year effort, in collaboration with the scientific community, to inform the citizens about this important issue. According to the comparative results recorded by the ECDC, the Greek consumption of antibiotics is twice to six times compared to the other European countries, already from 2009 to 2020, with the lowest consumptions being found in the northern countries of Europe.

In the context of the press conference, the data of a survey carried out for the 10th consecutive year by KAPA Research, on behalf of ISA and the Hellenic Society of Chemotherapy, was given, from which it emerged that one in four Greeks keeps some antibiotic at home in case of need!

The encouraging thing is that with the introduction of the mandatory prescription of antibiotics in 2020, their reckless use has been significantly reduced. But the reduction, according to scientists, is “fragile” if we don’t change our mindset.

Disappointing findings

The research on the consumption of antibiotics in Greece has been carried out since 2013. This year it was carried out between November 4-7 in a sample of 1097 people, in the 13 Regions of the country.

According to the survey data, 3 out of 4 Greeks have taken an antibiotic in the last 12 months, while two out of ten have never taken an antibiotic. 16% took an antibiotic for dental reasons, 21% for various reasons of serious illness or surgery, 11% to treat infections and 19% cite persistent cough and respiratory problems or bronchitis as the cause.

A first positive conclusion that emerges from the data is that in the last decade the percentage of those taking antibiotics without a prescription has decreased significantly (from 16% in 2013 to 6% in 2023. The most important part of the decrease is recorded in the last two years ( from 12% in 2021 to 6% in 2023).However, a significant 32% continue to keep antibiotics in their home fridge for emergencies (this percentage is down slightly from 2013’s 36%).

A second positive conclusion concerns side effects. The percentage of people reporting side effects from antibiotic use will drop to 19% in 2023, from 26% in 2013. The use of antibiotics only with a doctor’s prescription appears to have contributed to the issue of side effects, as use is no longer thoughtless, but it is done by watching experts.

Finally, a large percentage of Greeks (55%) have heard or read that there is an overconsumption and unnecessary use of antibiotics in Greece, 35% state that they have heard about the need for antibiotics to be used only with a medical prescription, and only 3% have heard something about the resistance of microbes to antibiotics. And in these matters, the effort of the medical community seems to be paying off so that we have more informed citizens on the subject.

Antibiotics are not harmless and should not be consumed without a prescription

“Unfortunately, our country is still in an unfavorable position, holding the negative lead among European countries in the unnecessary consumption of antibiotics, which turns into a lead in the resistance of microbes. The unnecessary use of antibiotics is a public health issue of great importance, which concerns a large part of the global community. Citizens must understand that antibiotics are not harmless, and for this reason, they should not be consumed without a medical prescription,” said ISA President George Patoulis. As he added, the Medical Association of Athens in collaboration with the Hellenic Intermunicipal Network of Healthy Cities of the P.O.Y and the Hellenic Society of Chemotherapy, continues for the 10th year the nationwide information campaign on the topic “Myths and truths about antibiotics and vaccines” with aimed at informing the public about this serious issue and protecting public health.

Why Greeks overconsume antibiotics

Emeritus professor of Pathology at the Medical School of the University of Athens, infectious disease specialist, president of the Greek National Academy of Sciences, member of the Board of Directors. of the Hellenic Society of Chemotherapy, Kyriaki Kanellakopoulou, reported that a high percentage of Greeks insist on taking antibiotics for simple viruses, in which, by definition, they are not effective. As the professor explained, most of the infections that happen to us in the winter, such as otitis, bronchitis, sinusitis and the “common cold”, which manifests itself with runny nose, cough, sore throat, muscle pain, bone pain and fever, are viruses that they heal on their own in about three days. Antibiotics are only necessary for serious bacterial infections, which will be diagnosed by a doctor.

He noted that despite the fact that antibiotics are only prescription drugs from 2020, it appears that patients are “pushing” their doctor to give them an antibiotic.

Consequences of overconsumption

According to Ms. Kanelakopoulou, consequences of overconsumption are side effects such as e.g. rashes, bronchial asthma and the allergic shock that threatens the very life of the patient, kidney and liver toxicity, severe diarrheal syndromes, such as pseudomembranous colitis with a mortality rate exceeding 20% ​​of those affected. Also, recent research has shown that children who took antibiotics before the age of 6 months will become obese. But the worst side effect concerns the development of resistance of microbes to antibiotics, so that the latter are no longer active in microbial infections. Unfortunately, our country also holds the lead among European countries in terms of resistance, so that at least for the microbes that will most often cause sinusitis and pneumonia, such as pneumococcus, the resistance ranges between 40-60% for the indicated antibiotics, such as macrolides and cephalosporins, for the colibacilli that usually cause urinary tract infections, resistance to ampicillin exceeds 50%, while to quinolones it exceeds 20%, so that their empirical administration is prohibited”.

Greece: negative first for the 13th year

Emeritus Professor of Pathology at the Medical School of the University of Athens, infectious disease specialist, president of the Hellenic Society of Chemotherapy Eleni Giamarellou, emphasized that Greece continues in 2023, its sad first place among the countries of Europe, in terms of the abuse of antibiotics and the highest rates of resistance of microbes to antibiotics, both in the community – with up to six times higher rates of antibiotic consumption compared to other European countries – and in hospitals, where last-generation drugs such as carbapenems have now lost their effectiveness
their urbanity in the face of the rise of multi-resistant microbes, according to data from the European Center for Disease Prevention and Control (ECDC).

In 2019, 1.27 million people died due to multidrug resistance, while for another 4.9 million, their death was attributed to multidrug-resistant microbes. In Europe, at least for 2020, multidrug-resistant infections exceeded 800,000, causing 35,000 deaths.

The position of Greece

As Mrs Giamarellou explained, based on ECDC data, we are also here, among European countries, first with 20 deaths per 100,000 population, followed by Italy with 19, Cyprus and Portugal with 10, Poland with 9, to reach only 2 deaths in Norway and the Netherlands. At the same time, again based on ECDC registration data, we are the first country in Europe in consumption of carbapenems in 2020, valuable antibiotics for the treatment of hospital-acquired infections, the overconsumption of which leads to their resistance and disuse.

Mrs. Giamarellou proposes as a solution the presence of a specially trained infectious disease specialist and a pharmacist, full-time and full-time, at least in every tertiary hospital, who will undertake the supervision of the prescription of antibiotics in collaboration with the treating doctors.

For the 13th consecutive year, our country is fighting its unequal battle against the misuse of antibiotics, focusing the concerns of Greek and European scientists on the triptych: Education, personal responsibility, political will for special treatment in the community and hospitals, as well as the cost of antimicrobial resistance in human lives and the burden on health systems is constantly increasing.

The only solution that remains for the Greek citizen, however, is the rational use of existing antibiotics, since it has been proven that if our flora are not “treated” with antibiotics, at least for 3-6 months, then the resistant clones disappear and the sensitive ones prevail – to antibiotics – microbial populations, proving once again the enormous responsibility of all of us, whether as doctors, as a society, or as patients.