Without a Prescription: Antibiotic Misuse Common in Eurasia

About a third of people surveyed in the Western Balkans, Caucasus, and Central Asia have used antibiotics in the last year without a prescription, according to the results of a survey published last week in Frontiers in Public Health. The finding highlights major gaps in public knowledge about antimicrobial resistance (AMR), as well as an urgent need to raise awareness about the consequences of misusing and overusing antibiotics.

The 8221 respondents to the survey were from the capital cities of Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, Tajikistan, Türkiye, and Uzbekistan.

They said they took antibiotics to treat colds (24%), sore throat (21%), cough (18%), and flu-like symptoms (16%), most of which are caused by viruses and against which antibiotics are ineffective.

Of all the respondents, 50% believed that the statement "antibiotics are effective against colds" is true, while just 36% correctly said it is false. Another 43% incorrectly believed that "antibiotics kill viruses," while 39% correctly said it is false.

AMR Should Be Household Word

"A lot of people don’t know what antimicrobial resistance is, and the word antimicrobial spans many kinds of medicines, [including] antivirals and antifungals," co-author Danilo Lo Fo Wong, regional advisor control of AMR for the WHO Regional Office for Europe, told Medscape Medical News. "We need to get to a point where people know what it is and what they need to do, but no longer think much about what the letters stand for, like HIV."

"AMR needs to be a household term; something that people accept as their responsibility, like recycling," he said. "Raising awareness about AMR is achievable, [but] the difficulty is bringing together many different sectors of society."

Nearly 40% of survey respondents did express an interest in learning about the appropriate use of antibiotics and their purpose.

The results of the survey also suggest that doctors and other healthcare professionals will have a pivotal role to play in raising awareness about AMR, with 80% of the respondents saying that doctors are the most trusted source of medical information.

"People go to doctors to seek help and get well. Evidence shows that people trust doctors and other healthcare professionals, making them the ideal gatekeepers for responsible use of antimicrobial medicines and messengers for raising awareness on AMR," said Wong.

"Every time antimicrobials are prescribed and dispensed there should be a conversation about responsible use and why it is important. Doctors should also be able to explain convincingly when antibiotics are not needed, and [other] healthcare professionals should be empowered with training in antimicrobial stewardship, as their role is crucial."

500,000 Deaths in Europe Annually

For the purposes of the survey, the researchers adapted a questionnaire developed by the European Commission to periodically collect data about antibiotic use from European Union countries. Using the same method to gather data provides a better overview of AMR and antibiotic misuse across Europe and could foster stronger pan-European interventions.

The data was collected during face-to-face interviews.

An estimated 5 million deaths every year are associated with bacterial AMR worldwide. More than 500,000 of these deaths occur in the WHO European Region, which comprises 53 member states in Europe and central Asia.

Without immediate intervention, the WHO said in a press release, AMR could result in up to 10 million deaths a year by 2050. This burden falls disproportionately on low- and middle-income countries, exacerbating global health inequities.

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