Drivers of Irrational Use of Antibiotics in Europe

Abstract

The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient–doctor interaction as major factors among healthcare providers. We further discuss initiatives that, if taken and implemented, can have an impact on and improve the current situation in Europe.

Antimicrobial Use in Extensive Smallholder Livestock Farming Systems in Ethiopia: Knowledge, Attitudes, and Practices of Livestock Keepers

“…However, infection prevention and control measures are crucial in order to reduce the incidence of infections and, therefore, reduce the need for antibiotics (40)(41)(42). Besides, the non-involvement of laboratory investigations in disease diagnosis prior to antimicrobial further fuels inappropriate use of antimicrobials, which may subsequently lead to the development and spread of AMR (43,44), which definitely is a big challenge in Ethiopia. Despite the frequent use of antimicrobials by smallholder farmers to maintain good livestock health and production in the studied areas, there was overall poor knowledge about the purpose of antibiotics and their proper use.…”

“…Besides the education barrier, limited professional supervision can also have an impact on a farmer's practice as reflected in the pastoral production system. Wrong public perception, attitudes, and beliefs about antibiotics are strong determinants of medically irrational use of antibiotics (43). It has been suggested that increasing knowledge and awareness about antibiotics and antibiotic resistance are key components of rational antibiotic use in human medicine (6,7).…”

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection

“…Antibiotic resistance has been emerging worldwide . Patient behaviour, treatment adherence, leftover antibiotics and drug waste should be identified as potential targets for restraining antibiotic resistance, and these may be of greatest interest in primary care, outpatient setting or for infections with great prevalence . Considering the latter, it is estimated that 50% of the world's population will be infected with Helicobacter pylori .…”

“…Furthermore, it is well‐established that patient compliance is inversely related to the number of drugs that the patient it taking . Previous research indicates that leftover antibiotics may contribute to inappropriate antibiotic consumption hence further promoting antibiotic resistance . Drug waste may also contribute to antibiotic resistance and raise healthcare cost .…”

“…[13][14][15] Previous research indicates that leftover antibiotics may contribute to inappropriate antibiotic consumption hence further promoting antibiotic resistance. 6 Drug waste may also contribute to antibiotic resistance and raise healthcare cost. 16,17 Considering the prevalence of H pylori infection, arguments and the complexity for its treatment, poor accordance of registered drug packs or poor patient adherence to the treatment may contribute to antibiotic resistance and healthcare costs.…”