What is antibiotic resistance and why does it happen?

Antibiotic resistance is when an antibiotic that previously treated a bacterial infection stops working as effectively or stops working completely. This reduces treatment options and makes common infections more difficult to treat. This in turn increases the risk of diseases spreading and causing more severe illness and death.

How over-prescribing antibiotics contributes to this problem

Antibiotic resistance happens naturally over time. But it also results from the overprescribing of antibiotics. This happens in two main ways:

  1. About 80% of all antibiotics are prescribed in general practice, and most of these are prescribed for respiratory infections. This is despite the fact that these infections are self-limiting and not do not require antibiotics.
  2. Even though many community infections are viral, and antibiotics only treat bacterial infections, patients are often prescribed antibiotics anyway. This is because it can make them feel validated (i.e., that their symptoms were severe enough to get a prescription). This is why public information campaigns on this problem generally focus on reminding patients, GPs and pharmacists that antibiotics only work for bacterial infections. Thanks to the COVID-19 pandemic, however, there is a greater awareness of viral infections, and the fact that antibiotics do not treat them.

If this over-prescribing is reduced, antibiotic resistance will also reduce.

How the COVID-19 pandemic changed the prescribing of antibiotics

GPs and pharmacists are at the forefront of delivering community care. At the start of the pandemic, they had to change how they did this. For example, GPs suddenly switched from face-to-face to phone consultations. GPs also began prescribing antibiotics less. For example, the European ValueDx study showed that in Ireland, the number of antibiotics prescribed for respiratory infections in general practice dropped from 54% in January 2020 to 20% in January 2021.  However, in 2022 it increased again to 30%. Compared to other European countries with an average of 15% in 2022, this is very high. Indeed, Ireland is one of the highest antibiotic-prescribing European countries. This needs to be addressed.  

How our HRB-funded research is tackling the problem

Research can reduce over-prescribing of antibiotics by providing GPs with more certainty on when to prescribe them. We have two research projects where we are collaborating with GPs and pharmacists to help achieve this:

1) The CARA Network (funded by a HRB Research Leader Award to Professor Akke Vellinga):

The CARA Network aims to provide an open-access data infrastructure which helps GPs understand and improve how they prescribe antibiotics. They do this by uploading their practice data to a dashboard with our CARAconnect tool, which allows them to visualise how they prescribe antibiotics and compare this to other GPs, and ultimately generate an audit that can help them to identify if they are over-prescribing. This process is currently being tested, with a view to launching it in 2023 to all GPs in Ireland.

2) The DARINA project (DiAgnostics for Respiratory Infections: a Narrative Assessment of point-of-care) project (funded by a HRB Investigator-Led Project award to Professor Cristín Ryan and co-investigator Professor Akke Vellinga):

The use of point-of-care diagnostics for infections other than COVID-19 is not widespread in Ireland. This HRB funding will support us to develop best practice guidance for using it to manage respiratory tract infections; explore whether the pharmacy or general practice is the best place to do these diagnostic tests; and to propose how these tests could be embedded into routine clinical practice.

How other research is tackling the problem

Five general practices in Ireland are enrolled in the European PRUDENCE trial. This sees them use devices to check if a patient has flu (influenza A or influenza B), a throat infection or a high C-reactive protein (also known as CRP, which if high indicates a bacterial infection). With these easy-to-use tests, the GP can determine if a bacterial infection is present and make a more informed decision on antibiotic prescribing.

Professor Vellinga and her team are also involved in ECRAID (the European Clinical Research Alliance on Infectious Diseases). This network will test new treatments for respiratory infections as they emerge and offers an exciting opportunity to be at the forefront of new therapeutics in primary care.

The future

Antibiotic resistance is often referred to as a ‘wicked problem’. This means that there is no one solution to it. What we do know, however, is that we must tackle it from many different angles; that research must therefore be collaborative, integrated and multi-disciplinary; and that it must involve patients and their care providers.

ENDS

Further information:

Visit the Cara Network website where you can subscribe to its newsletter to keep updated on all its progress

Learn more about European Antibiotic Awareness Day

About the authors:

Akke Vellinga is epidemiologist and Ad Astra Professor in the School of Public Health, Physiotherapy and Sports Science at University College Dublin. She is a HRB Research Leader on the CARA Network (Collaboration to reduce Antimicrobial use and Resistance and identify opportunities for improvement and Awareness); and the Irish lead in the European Clinical trial platform for Infectious Disease (ECRAID) as well as the ValueDx study on introducing diagnostics to improve antibiotic prescribing in general practice.

Cristín Ryan is a Professor in Practice of Pharmacy, Trinity College Dublin. She has recently been awarded a HRB Investigator-Led Project award to develop an intervention to improve the use of point-of-care diagnostics in the management of respiratory tract infections in primary care.