Saturday 20 January 2018

The best and worst counties for antibiotics consumption

Highest rates of use are found in Mayo, Longford and Westmeath

Caroline Crawford and Eilish O'Regan

Patients in Mayo, Longford and Westmeath consume more antibiotics prescribed by their GPs than the rest of the country, according to new figures.

Other counties, which also have high rates of antibiotic use are Cork, Limerick, Tipperary, Donegal and Galway, while the lowest consumers are found in Kilkenny, Meath, Roscommon, Wicklow and Clare.

The findings, based on supplies of the drugs purchased by pharmacies which fill GP prescriptions in each of the counties, come amid ongoing concern about the overuse of antibiotics which are ineffective at treating colds but are fuelling killer superbugs.

While it is unclear if it is patients taking higher doses or long-lasting courses of the drugs which are pushing up the need for pharmacies to buy so many antibiotics in counties at the top of the league, the worrying trend helps explain why Ireland is still only mid-way in Europe in the fight to curb their unnecessary use.

The Irish Independent can reveal that GPs have been forced to stop prescribing some antibiotics to patients who have become too resistant to them from overuse.

Antibiotics cannot be used once they hit a resistance pattern of 20pc. This has now become an issue for surgeries around the country.

"That's one in five patients we can't use it on. It can be difficult to monitor because we don't send every sample off for testing, but Galway hospital is very helpful in checking samples as they want to monitor the trend," said Dr Andrew Murphy, Professor of General Practice at NUI, Galway.

A number of antibiotics including Trimethoprim, Amoxicillin and Ampicillin, used for a range of illnesses, are now unable to be used in many parts of the country. Other vital antibiotics are also being monitored to ensure they don't pass the 20pc mark. One such drug is Ciprofloxacin, which is used in chest infections, urinary tract infections (UTIs), infections of the digestive system, bone and joint infections.

Dr Murphy said in his surgery in Turloughmore, Co Galway they could no longer prescribe Trimethoprim, used to treat urinary tract infections.

"In our own practice, we can no longer use it as it's above 20pc resistance. It was a very useful antibiotic so that is a loss," he added.

In the same practice, the resistance level for Ciproflaxin, commonly known as Ciproxin, has dramatically increased.

"Ten years ago, the resistance level for Ciproxin was 1pc to 2pc. Now it's up to 9pc. We can still use it but if that trend continues we will end up without it," warned Dr Murphy.

Dr Nuala O'Connor, Irish College of General Practitioners (ICGP) lead advisor on Antibiotic Resistance, said the problem was occurring right around the country.

"Within very short time of any new antibiotic being used, bugs start to develop resistance.

"This means that they become less useful for treating certain infections, eg. trimethoprim is first line drug for treating UTIs. But the resistance rates are rising, so depending on where you practice and the type of person you are treating, there is now about 30pc chance that this antibiotic will not treat their UTI," she said.

She explained how another antibiotic, Amoxycillin, which was a common treatment for UTIs, can now only be used if the GP has received confirmation from a lab that the patient has a bug sensitive to this.

"We often wish to use this in pregnant women as it is a very safe antibiotic in this group of patients, but the community resistance in the bugs that commonly cause UTI is now over 50pc all over Ireland," she said.

"We also know that bugs seem to develop resistance to some antibiotics easier than others, for example ciprofloxacin resistance has increased very rapidly - from 2pc to 12pc between 1992 and 2011 in UTI specimens analysed in Cork University Hospital - so we want to keep this one for when we really need it."

Martin Cormican, Prof of Bacteriology at the School of Medicine at NUI Galway, said the resistance rate had changed how doctors could treat patients.

"When somebody goes into their GP or hospital we don't know right away what is making them sick.

"We can tell from the clinical story that they probably have an infection but we don't know what bug is causing it.

"We used to be able to use a number of antibiotics that would work on a number of bugs, but that has become much harder to do.

"Thirty years ago, we could use either Trimethoprim or Ampicillin and they would work on the illness.

"Now we can't use either, the resistance is so high," he added.

However, in recent years the dependence on antibiotics has slowly decreased. Irish people are becoming more aware of the need to avoid antibiotics for common cold and flu after decades of misuse, according to Dr Murphy.

He said doctors had also stopped prescribing antibiotics for certain illnesses thanks to research changing trends.

"When I started out we would prescribe antibiotics for sore throats all the time because we were worried about the secondary damage to the kidneys but that has changed now after research showed antibiotics were making no difference and had no impact on reducing secondary kidney problems," he added.

Last year the World Health Organisation warned that Ireland is among the countries where resistant superbugs are on the march, posing particular risk to vulnerable patients whose defences are low. It looked at 114 countries.

Irish Independent

Promoted Links

Today's news headlines, directly to your inbox every morning.

Promoted Links

Editor's Choice

Also in Irish News