Health Centres in Alicante Reduce Antibiotic Prescriptions by 30% to Combat Bacterial Infections

The population of the European Mediterranean arc tends to use more pharmaceuticals than other parts of the continent. Cultural reasons or the false perception of the infallible effect of some drugs help to understand this reality. However, the abuse of some of these pharmaceutical treatments can be counterproductive, especially in the case of antibiotics.

Behind the sometimes indiscriminate use of antibiotics lies the risk that bacteria causing infections become increasingly resistant to these pharmaceutical treatments. "Many patients tend to think that an antibiotic cures everything; however, they can become harmful if not used properly," explains Dr Esperanza Merino, head of the Antibiotic Use Optimisation Programme (PROA) for hospital care at the General Hospital of Alicante. Examples of ineffective use of antibiotics include their erroneous prescription for treating viruses (and not bacteria), an insufficient number of doses, as well as a more prolonged treatment than necessary.

To understand the magnitude of the situation, it should be noted that one in three people in Alicante were prescribed antibiotics last year. Of all the infections for which these drugs are prescribed, pharyngotonsillitis is the most common among patients in the General Hospital of Alicante's health department.

For this infection alone, health centres in the Alicante department have managed, over the past five years, to reduce antibiotic treatments from 30,000 annually to 21,000. This 30% reduction has improved the resistance of bacteria causing many infections to antibiotics. This is explained by Marta Aparicio, a primary care pharmacist and counterpart to Dr Merino for the supervision of the PROA in the health centres of the same department, where 80% of the medications are prescribed, compared to 20% in the hospital.

Some examples of improvement in the bacterial fight include a 12% reduction (to a total of 23%) in the resistance of pseudomonas (one of the most aggressive germs) to treatment with carbapenems. The latter is a broad-spectrum antibiotic that can act against many types of bacteria. However, this broad range of action can be counterproductive, as this greater generalised use exposes it to a loss of efficacy in its effects.

In this regard, Aparicio explains that one of the strategies adopted to better target treatment has been the generalisation of streptococcus diagnostic tests—as well as the training of healthcare professionals for their correct use—in all health centres in the Alicante department. "A more precise diagnosis allows healthcare professionals to choose more effective and safer antibiotics."

In the field of prevention, vaccinations also help prevent further infections, and with the coldest season of the year approaching, the flu is the best example, as its consequences can be lethal for vulnerable patients, such as the elderly or immunocompromised.

Public education and awareness also play an important role in the fight against bacterial resistance. Simple hygienic habits such as hand washing can save many lives, and as Dr Aparicio explains, the danger posed by many microorganisms "is no longer so much in their aggressiveness, but in their ease of contagion, as demonstrated by COVID-19."

It was precisely during the pandemic that the heads of the PROA in the Alicante department were able to witness how education can reduce the use of antibiotics. Antibiotic prescriptions were reduced by up to 75% during the coronavirus pandemic thanks to an information campaign aimed exclusively at doctors. "We now also need to seek support in the field of community pharmacy, where most of the population obtains antibiotics, to ensure that these are dispensed only with a medical prescription," explains the head of the PROA at the General Hospital of Alicante.