Keep antibiotics working – limit their use this flu season

WHO

Antibiotics cannot cure infections caused by viruses. This fact is well known to clinicians, and in recent years it has become more widely known among the general public. Despite this growing awareness, every year the influenza season leads to increased use of antibiotics.

In the winter months, various studies have observed increases in prescribing of antibiotics, in particular for upper-respiratory tract infections in children aged 0–3 years. While antibiotics can be useful in some cases of secondary bacterial infection, they do not help influenza infection itself.

Surveys have shown that 64% of respondents incorrectly believed that colds and influenza could be treated with antibiotics. Most cases of influenza resolve themselves; others can be treated with antiviral medication.

Antibiotics need to be used with care to preserve their effectiveness for when they are truly needed. To advise doctors on which antibiotics to use for common infections and which to preserve for the most serious ones, WHO divided antibiotics into 3 categories in its Model List of Essential Medicines: Access, Watch and Reserve.

  • The Access group comprises antibiotics that are first and second choices for common infections. They should be widely available.
  • The Watch group includes antibiotic classes that should be prescribed only for specific indications because there is a higher risk of bacterial resistance developing.
  • The Reserve group consists of last-resort options.

Janusz did not give up

The story of Janusz Ochnio and his wife Halina demonstrates the importance of keeping antibiotics working so they are effective when we need them most. The couple, who live in Poland, had high hopes of resuming a normal, healthy life together when Janusz underwent a kidney transplant 2 years ago. Unfortunately, the transplant failed and he had to resume dialysis.

Worse still, Janusz suffered a stroke in the summer of 2018. While in hospital for treatment for the stroke, he developed a cough. His wife remembers, “When I came to visit him I could already hear him coughing as I came up the stairs; he was almost suffocating.”

The couple was transferred 100 kilometres from their local hospital to the Department of Transplantation Medicine and Nephrology at Infant Jesus Clinical Hospital in Warsaw. There, a bronchoscopy detected multidrug-resistant Klebsiella pneumoniae, a bacterium that is resistant to a wide spectrum of antibiotics.

Far from home and unable to receive visitors, the couple entered an anxious and lonely period. Halina remembers, “This bacterium is resistant to most antibiotics and forced us into isolation. My husband is blind, only recognizing people around him by their voice. In a new place, I had to be with him all the time. I stopped working to look after him. There was no one to replace me, I couldn’t ask our children because they have small kids themselves and I would not like to expose them to this hazard.”

Luckily, in this case the bacterium was sensitive to meropenem, an antibiotic that WHO recommends clinicians reserve for such difficult-to-treat cases. After several weeks of treatment Janusz was discharged, to the relief of his wife. “Janusz did not give up. He managed to walk again and return to his normal activity after the stroke and this horrible pneumonia. I am so grateful to all the doctors who helped him so much.”

Protecting medically important antimicrobials

Meropenem is in the Watch group on the WHO Model List of Essential Medicines. It is also on the WHO List of Critically Important Antimicrobials for Human Medicine, a system of classification aimed at limiting the use of medically important antimicrobials in the production of food animals.

“Janusz’s case highlights just how dangerous antibiotic resistance can be,” explains Dr Danilo Lo Fo Wong, Programme Manager for Antimicrobial Resistance at WHO/Europe. “We cannot take antibiotics for granted and we need to be especially vigilant about overuse during the influenza season. It is vitally important for the health of future generations that we treat antibiotics with respect, so they are there for us when we need them. Janusz’s story also shows how important it is to respect lists of essential antibiotics and strictly limit their use for very specific cases, like his.”

The influenza programme at WHO/Europe provides guidance on the diagnosis and treatment of influenza. Dr Caroline Brown, Programme Manager in the Division of Health Emergencies and Communicable Diseases at WHO/Europe, highlights: “Our guidance aims to encourage the appropriate use by clinicians of influenza antiviral treatment as well as antibiotic treatment of secondary bacterial infections, which have been found in approximately 30% of fatal cases.”