Specialists want curb on prescribing of antibiotics

DOCTORS have called for restrictions on the prescribing of antibiotics in order to preserve their effectiveness.

This follow the publication of an international study assessing bacterial resistance to antibiotics. The study also gives the first national picture of resistance to antibiotics in Ireland.

Prof Conor Keane, consultant microbiologist at St James's Hospital, Dublin, was co ordinating microbiologist for the Irish study. Matching studies were conducted in other countries.

Prof Keane called for some restrictions to be placed on the prescription of antibiotics and suggested that hospitals should have some policy to review the results of treatment of patients with antibiotics.

"The number of new antibiotics coming on stream is very small. So there is an argument for the conservation of existing antibiotics or for a different approach in the treatment of infections," he said.

Dr Luke Clancy, consultant physician in respiratory diseases at St James's Hospital, said the message was for the community as well as for GPs. The public should not put pressure on doctors to prescribe antibiotics ford what might be considered trivial illnesses.

The study, carried out by Rhone Poulenc Rorer over the 1994/95 winter period, involved 10 countries, including Ireland, and almost 1,900 patients, 11 per cent of them in Ireland.

The tests in Ireland were carried out at nine centres and the results were divided into regional areas, Dublin, Cork/Waterford and Galway/Limerick. The project looked at the resistance levels of bacteria to a number of antibiotics in chest infections, chronic bronchitis and pneumonia.

At an international level the study found that bacteria in pneumonia had the highest levels of resistance in Spain (52 per cent), but very low resistance (0-3 per cent) in Britain and Germany.

Ireland had a resistance level of 7.5 per cent. It was also found that, in 90 per cent of cases where there was a resistance to penicillin, the bacteria were resistant to other antibiotics as well.

Prof Keane pointed out that, while the 7.5 per cent resistance level might seem low, it could rise in the future. In other countries where the resistance levels had been 7 per cent some years ago there were now "huge problems" with resistance. The greatest bacterial resistance to antibiotics was found in countries where there was uncontrolled access to antibiotics.

"The demand for antibiotics has to be overcome and rationalised", Dr Clancy said. Using ineffective antibiotics increased resistance. Referring to a multi drug resistant tuberculosis occurring in the US, he said that this was now a major problem "almost entirely down to bad use of antibiotics".