Antibiotic resistance is a complex issue – there is no easy fix

An interview with Peet Tüll

The challenges in tackling antibiotic resistance

“The European Union (EU) countries clearly see that the problem of antibiotic resistance exists. However, we cannot be sure how informed people outside the EU might be.”

“It is important to highlight that there are experts who are aware of this issue in every country, and often what is lacking is not the knowledge or the evidence but rather the support from their colleagues or governing bodies.”

“I believe that some of the greatest challenges in fighting antibiotic resistance include:

• how to stop over-the-counter antibiotic sales, especially in non-EU countries; and
• ensuring that countries fully comply with the legislation that exists prohibiting over-the-counter sales.”

“Further, antibiotic resistance has two legs:

• Antibiotic usage: how to make sure that physicians use antibiotics appropriately when they are necessary. There are misunderstandings, both from the patients and doctors, on when antibiotics should be prescribed and used. In studies based on Scandinavia, antibiotic misuse in hospitals was reported to be 30–40%, meaning that people were not complying with the set guidelines. About 90% of infections occur in outpatient units. There is overuse in outpatient settings. There is a three-fold difference in the use of antibiotics in EU countries, which does not seem to reflect a three-fold difference in disease.
• Resistant bacteria and resistance genes are spreading, and keeping up with infection control is a challenge. Antibiotic resistance is an issue to consider in health care systems and hospitals due to the high levels of infection and the transmission of resistant strains in these settings.”

“Another challenge is how to coordinate with other sectors, including agriculture, regarding their use of antibiotics. Feeding antibiotics to animals promotes their growth: it has been forbidden to use them for this purpose, but this is difficult to control.”

“It is a challenge to combat antibiotic resistance when there the drugs have such few direct side effects.”

“There is no easy fix to the problem, due to its complex nature. Think of the roses you might have bought at the flower shop the other day. Those flowers are very likely to have been sprayed with antibiotics.”

The emergence of a new health concern

“The topic of resistance began to be discussed at high-level official meetings in about 1994. In Sweden, various expert groups were formed, including Strama (a network of national and local coordinating groups to combat antimicrobial resistance), and a national strategy for Sweden was written and presented in 2000. The first EU meeting on antibiotic resistance took place in Copenhagen in 1999. WHO followed shortly after with a global strategy in 2001. This resulted in important recommendations that are still relevant today.”

“These documents and recommendations have served as a reference for countries to draft their own national guidelines from the country to the hospital level. Following that first EU meeting, proposals were made on behalf of the European Economic and Social Committee to the European Commission, and a few years later, in 2002, health ministers in Europe came together to agree and sign the Council recommendation on the prudent use of antimicrobial agents in human medicine (2002/77/EC).”

About Peet Tüll

Peet Tüll is a physician specializing in infectious diseases, was head of the Department of Infectious Diseases at Visby Hospital in Sweden for many years, and later became the Director of the Division of Communicable Disease Prevention and Control of Sweden’s National Board of Health and Welfare. Peet Tüll has also worked for WHO and helped establish the European Centre for Disease Prevention and Control. Today, he advises countries on their strategies for combating antibiotic resistance.