In Belgium, antibiotic use this year is lower than in 2016, but higher than in 2019, just before the pandemic, raising concerns that this will further drive resistance to treatments.
Antibiotics fight infections caused by bacteria. However, the overuse of these drugs – especially taking them incorrectly – promotes antibiotic resistance.
Antibiotic resistance is widespread in Europe and is increasingly considered to be one of the main challenges for public health on the continent. Aside from having an impact on healthcare spending and the success rate of antibiotic treatments, it can even result in death.
For years now, Belgium has scored badly regarding antibiotic use in comparison to other EU Member States. When it comes to average use, which is expressed in so-called standard daily doses per 1,000 inhabitants per day (DID), the country scored significantly higher than the European average (16 DID compared to 15) in 2021.
More recent data collected by Independent Health Insurance Funds from their 2.2 million members also confirms this.
The percentage of members that used antibiotics between 1 July 2016 and 30 June 2017 stood at 34.2%. This figure dropped significantly during the pandemic years, reaching its lowest level between July 2020 and June 2021 (23.2%). However, the same period up until the end of June this year showed that it once again increased to 32.5%.
"This still leaves us far from the targets set by the Federal Health Care Knowledge Centre (KCE) and the Belgian One Health Antimicrobial Awareness action plan," the association stated. This action plan proposes a gradual, overall 40% decrease in total antibiotic use compared to 2019. "Instead, we have noted an annual increase since 2020."
Users and prescribers
Most of the antibiotics prescribed outside hospitals are given by general practitioners (GPs), followed by dentists. While the Independent Health Insurance Funds report noted that the observed strong variation between different professional groups (for instance, GPs and paediatricians) is not surprising, the variation within medical specialisations is quite striking.
"For instance, a quarter of all general practitioners prescribe antibiotics to a maximum of 9% of patients on an annual basis, while another quarter prescribes antibiotics to at least 22% of patients. While this could certainly be due to differences in patient population, it suggests that there may be much to be gained by allowing doctors to compare their prescribing behaviour with scientific guidelines and the prescribing behaviour of colleagues," the report read.
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Chronically ill people and those in residential care homes are more likely to take antibiotics, but more worryingly, children under five are also among the biggest users.
"It is characteristic that young children are also among the biggest users. They very often involve respiratory infections, such as middle ear infections. In some cases, proper treatment with antibiotics is very important," said Ruud Saerens, physician expert at the Independent Health Insurance Funds. However, he noted that in other cases, symptom control will be the preferred method at first, unless there are specific clinical indications.
"In any case, as a parent, it is very important to take your doctor's prescriptions on board. Never start treatment on your own – with leftover antibiotics, for example – and respect the duration and dose as prescribed," Saerens stressed.
Decreasing use
To ensure a decrease in antibiotic use, guidelines do exist for patients, prescribers and governments alike. The KCE has recommended that second-line antibiotics (such as amoxicillin-clavulanic or clarithromycin) should only be used if the first-line treatment (such as amoxicillin) was not efficient or for certain infections that are difficult to treat. For the first months of 2023, the share of second-line antibiotics is 47%, while the ratio should be 80%-20%.
Ann Ceuppens, Director of Studies and Representation, noted that preventive measures can also help reduce antibiotic use, such as hand hygiene and covering noses and mouths with the inside of an elbow when coughing or sneezing. "Whenever possible, vaccination also contributes to prevention."
However, Ceuppens also stressed that antibiotic prescribers could be further supported, and monitoring of prescribing and consumption behaviour could be improved.
