Antibiotic use in Scotland 'three times recommended level'
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Antibiotic use in Scotland is three times the level recommended by experts to head off a superbug crisis that could threaten modern medicine as we know it, a leading microbiologist has warned.
The rise of antibiotic resistant infections could render routine procedures such as hip replacements so risky that four-fifths of patients could die, Scottish Government infection adviser Alistair Leonard said.
Experts say there should be no more than 250 antibiotic prescriptions per 1,000 people per year.
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Professor Leonard said: "Sweden are ahead of us, as are the Netherlands, sitting at around 300 prescriptions a year.
"Scotland is at 700. We are twice the best in Europe, and we’re almost three times what experts say we should be. We’re not even close."
Scottish hospitals use more antibiotics than the other nations in the UK, he told an Infection Prevention and Control conference in Edinburgh.
Antibiotic resistance is predicted to be the biggest cause of death in world by 2050 — with the potential to claim 50 million lives around the world.
An outbreak of antibiotic resistant infection in the UK could wipe out a town the size of Paisley.
Leonard, a consultant microbiologist at Queen Elizabeth University Hospital, said: "If we were to have an outbreak today, the UK Risk Register estimates that it would be around 200,000 effected patients with AMR, of which 80,000 would die.
"So we are actually in a time when this could be quite significant."
Around 1,000 tonnes of antibiotics are used in the UK every year, with around half used on animals, Leonard told the Holyrood conference.
Leonard said: "1,000 tonnes of bricks isn’t that much but this is 1,000 tonnes of drugs that we will use in milligram quantities — so that’s a lot of drugs."
He said the UK "could do better, but could do worse" in antibiotics use, sitting around mid table in the European league in which Greece and Belgium are the worst and the Scandinavian countries the best.
He said there have been no antibiotics developed in at least the last decade, and warned: "Big Pharma isn’t going to get us out of this."
Leonard said infections such as sepsis have increased threefold in the last 20 years, and warned that the population of people aged over 75 is expected to almost double.
"People are getting sicker, they’re getting older, and we’re having to use to use more antibiotics just to stand still," he said.
He cited an Italian case study of a patient who had a hip replacement in 2010 and died of septicaemia three days later despite being given nearly every antibiotic available.
"Five years ago I couldn’t say this, but we see antibiotic profiles that look like this now in the Queen Elizabeth probably a couple of times a month," he said.
"Some of them are very serious infections, some of them not so. This man died.
"If I was to tell you that we do 15,000 hips, so this isn’t an unusual thing, and the mortality of that is 0.2 percent with around 1-2 percent infections.
"If you get one of these organisms the mortality rate goes from 40-80 percent, so it’s not only the treatment that it is affecting.
"What we are really looking at is we’re stopping the potential to perform modern medicine as we know it.
"We cannot have a conversation with people saying: 'If you have an infection you’ve got an 80 percent chance of dying from it.'
"That is not a conversation that we have had in the last 40 years, but it might be conversation that we have in the future."
Leonard said Scotland will be struggling with antibiotic resistance for many years to come.
"There really hasn’t been, despite everyone’s best efforts, a reduction in resistance," he said.
"Is that because you can’t have a reduction in resistance, and that once resistance is in the organism it stays there, or does it take longer?
"Well, I think it probably takes longer, so I’m not going to say this is bad news, I’m going try and give some good news."
He pointed to Swedish data where some resistance has declined, and suggested there may be signs of a plateau in resistance.
"We will never reduce resistance, but our mantra should be: how do we stop increasing."