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Antibiotic use dropped post-COVID. Which countries in Europe rely on them the most and least?

The downward trend in antibiotic use in Europe accelerated dramatically during the COVID-19 pandemic .
The downward trend in antibiotic use in Europe accelerated dramatically during the COVID-19 pandemic . Copyright Canva
Copyright Canva
By Servet Yanatma
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Antibiotic use dropped dramatically during the COVID pandemic. But some Europeans continue to take them without a justification.

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The downward trend in antibiotic use in Europe accelerated dramatically during the COVID-19 pandemic when it reached its lowest levels. However, a Eurobarometer survey found that a very large proportion of Europeans take antibiotics without justification. Their knowledge of antibiotics is also alarming.

Antibiotic use reached a record low in the EU in 2021, according to the Eurobarometer data. It decreased from 40 per cent in 2009 to 23 per cent in 2021. The COVID-19 pandemic may have been a major influencing factor in this decline. 

A lack of understanding about antibiotics, their uses, and their effects was also alarming with only half of the respondents knowing that they are ineffective against viruses.

The fieldwork for the survey took place in February and March 2022. As participants were asked about their use of antibiotics “in the last 12 months,” the findings primarily reflect the year 2021.

Which countries use antibiotics the most and least in Europe? What are the reasons for taking antibiotics? Are people well-informed? How did COVID-19 impact the consumption of antibiotics? This is what the data shows. 

Survey: Gradual downward trend in antibiotic use

According to Eurobarometer, there has been a gradual downward trend in the use of antibiotics in the EU. It decreased from 40 per cent in 2009 to 32 per cent in 2018, and then reached 23 per cent in 2021.

Impact of COVID-19 on antibiotic use

The significant fall in 2021 corresponds with the COVID-19 pandemic. "While the survey does not explore the underlying reasons behind this drop, one could surmise that the COVID-19 pandemic may have been a major influencing factor," Eurobarometer suggested.

When asked about the impact of COVID-19, over a quarter (28 per cent) of survey respondents said that the pandemic had decreased their need for antibiotics because they were ill less often due to strengthened personal protective measures such as masks, physical distancing, and better hand hygiene.

Data reveal decreased overall consumption of antibiotics

Besides the Eurobarometer survey, data from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) also show that the overall human consumption of antibiotics in the European Union/European Economic Area (EU/EEA) decreased by 23 per cent between 2011 and 2020. In particular, consumption dramatically declined during COVID-19. Between 2019 and 2020, the mean total consumption of antibiotics dropped by almost 18 per cent.

Germany and Sweden use the least antibiotics

The Eurobarometer survey and ESAC-Net data capture different aspects of antibiotic use. Among the respondents from the EU, 23 per cent said "yes" when asked "Have you taken any antibiotics orally such as tablets, powder or syrup in the last 12 months?"

Antibiotic use was found to vary from 15 per cent in Sweden and Germany to 42 per cent in Malta. In France (28 per cent), it was higher than the EU average.

Antibiotic consumption can also be expressed as defined daily doses (DDD) per 1,000 inhabitants per day. In 2021, this ranged from 8.3 DDD in the Netherlands to 25.7 DDD Romania.

France ranks fifth on the list of antibiotic consumption

Antibiotics were consumed at a rate of 21.5 DDD in France, which ranked fifth on the list. This rate was 20 DDD in Spain, 17.8 DDD in Ireland, 17.5 DDD in Italy and 10.1 DDD in Sweden. In England, it was 15.9 DDD in 2021.

8 per cent of antibiotics were consumed without prescriptions

According to the survey, 8 per cent of antibiotics consumed in the EU were taken without prescriptions. The vast majority of Europeans (92 per cent) had obtained their last course of antibiotics through a healthcare professional, either via a prescription or directly from a medical practitioner.

The highest proportions of people obtaining antibiotics from medical practitioners are found in Czechia (98 per cent), Poland (97 per cent) and Denmark (96 per cent), while the lowest are found in Romania (80 per cent), Austria and Belgium (both 84 per cent), and Hungary and Bulgaria (both 87 per cent).

More than half did not undergo testing before starting the antibiotics

Participants who consumed antibiotics in the last 12 months were also asked whether they had any tests performed, such as blood or urine tests or a throat swab, to determine the cause of their illness before or at the same time they started taking the antibiotics. 

More than half of Europeans (53 per cent) said they did not undergo any testing.

"Taking a test is important to discern whether an infection is truly caused by bacteria or a virus and should be standard practice before prescribing an antibiotic," the Eurobarometer report stated.

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Respondents who said they had testing performed varied from 29 per cent in Poland to 67 per cent in Czechia. Participants were also less likely to have undergone diagnostic testing in Romania (31 per cent) and the Netherlands and France (both 39 per cent).

Knowledge of antibiotics is alarming

In the EU, only half (50 per cent) of the respondents knew that antibiotics do not kill viruses. Almost two out of five (39 per cent) incorrectly thought that antibiotics kill viruses, and 11 per cent said they did not know.

A majority of Europeans (62 per cent) correctly stated that antibiotics are ineffective against colds, while 30 per cent incorrectly believed that they are effective against colds.

Reasons for taking antibiotics

Why do we need to take antibiotics? According to the Eurobarometer report, antibiotics are only effective against bacterial infections such as urinary tract infections or strep throat. 

They are not effective against viral infections such as COVID-19, colds, flu, and most types of sore throat, bronchitis, and sinus or ear infections.

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The survey concluded that a substantial proportion of Europeans are still citing reasons for taking antibiotics that are not fully justified.

About one-third (30 per cent) of participants said that they still generally took antibiotics for colds (11 per cent) or flu (10 per cent), and another 9 per cent reported having taken antibiotics for COVID-19. These are diseases generally caused by viruses, not bacteria.

Antimicrobial resistance (AMR) – the ability of microorganisms to resist antimicrobial treatments, especially antibiotics – has also a direct impact on human and animal health. AMR is responsible for an estimated 33,000 deaths per year in the EU according to the European Centre for Disease Prevention and Control (ECDC).

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