Jump in antibiotics consumption in Latvia

In the context of the recent shortage of medicines, the increase in antibiotic consumption in Latvia is raising attention. Doctors often prescribe them even in the event of a runny nose or cold, as if to ensure that the patient does not get any more serious. But such a tactic is not only wrong, it is also dangerous, infectologist Uga Dumpis told Latvian Radio on January 25.

Antibiotic consumption increased significantly last year. According to data from the State Agency of Medicines (ZVA), more than 2.2 million antibiotic packages were sold between January and November, excluding December, in 2022. In 2021 – more than 1.5 million, in 2020 – around 1.6 million.

Ilze Aizsilniece, president of the Latvian Medical Association, said that usually, the statistics reflect doses, but the packages tend to be different sizes, so operating with these figures is not exactly correct.

Aizsilniece said: "The defined daily dose has been confirmed in the world since 1996 and is accepted everywhere, and then statistics on the consumption of any medicinal product in the country are also carried out. It would also be recommended to the Latvian State Agency of Medicines."

However, the quantity of packages to be measured in millions is a sufficiently illustrative indicator, believes ZVA Deputy Director Sergejs Akuličs. He also pointed to other circumstances why there had been such a jump in consumption: "It is increasing because in the last two seasons, colds may not have been as noticeable as Covid. There were a variety of restrictive measures – with physical distancing, wearing masks, and particularly careful hand washing. Consequently, there was also less demand for medicines normally needed during the cold seasons. It should also be noted that last season the flu started not in autumn or winter, but the epidemiological threshold in Latvia was actually reached only in March. But this year, this season, we saw pretty big, solid numbers already in December."

In "simple terms", Akuličs said that not only Covid was spreading this season, but also influenza, respiratory syncytial virus, and other virus causing upper respiratory disease; very many are suffering.

However, the ZVA representative noted that antibiotic use is not effective in viral diseases, but in practice, antibiotic treatment is prescribed even for prevention, ensuring that the patient taking them will not suffer anything more serious.

The explanation is the overload of doctors.

The head of Jelgava Polyclinic, Kintija Barloti, said: "The queues are huge, the doctors are not enough, and the family doctors are overloaded. They prescribe a lot on the phone. You have symptoms like this? Then we prescribe. It is much easier to prescribe medicines, antibiotics, and to know that there will really be no problems than not prescribing and fighting patients who are not conscientious."

Antibiotics, as a first-choice drug for respiratory virus diseases, are not the right tactics; the use of these powerful medicines should be targeted and appropriate for the patient's health status, said Uga Dumpis, an infectologist at Pauls Stradiņš Clinical University Hospital.

“Another thing is that viral diseases can be transformed into bacterial complications, especially influenza, but in such a situation blood tests need to be carried out. Other inflammatory indicators typically appear in the tests. There may be situations where antibiotics have to be prescribed, but antibiotics do not mean prophylactic in such situations,” explained Dumpis.

According to ZVA, antibiotics that have been prescribed unnecessarily in conditions of medication shortages may mean that someone else who really needs them will have to seek it for a long time. However, even if there is no shortage of medicines, the use of antibiotics without indications is dangerous.

Dumpis said: 'Antibiotics also act on normal bacteria, normal microflora. Therefore, antibiotics, whether needed or not, change the human microbiome. The microbiome is a very important thing in modern medicine. Changing this microbiome can lead to all kinds of other health problems that we don't even know about. Most importantly, why antibiotics should not be used unnecessarily is the breeding of resistance in bacteria."

It is true that in Latvia the consumption of antibiotics is not as high as elsewhere in Europe; it is even below the average level of the European Union, however, currently the situation has a tendency to deteriorate – mainly due to the poor health literacy of people, considers the President of the Latvian Medical Association Aizsilniece.

“The interesting thing was that at the end of the 90s, Latvian schools taught health, and also in the early 2000s, health teachers talked about the rational use of medicines, about the use of antibiotics. It was a very big discussion. This could be seen – both children knew and young people knew, parents and teachers, and attitudes to antibiotic use changed. Currently, these results are not the worst, but have slightly deteriorated regarding the use of antibiotics in Latvia. It may have been affected by the events of recent years relating to the pandemic, but it is absolutely clear that health literacy in Latvia is the lowest in Europe. If there is no health literacy, there is also no knowledge of the correct use of antibiotics and antibiotic resistance."

 

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