One in Three People Use Antibiotics Without Prescription: WHO Study of Eastern Europe, Caucasus and Central Asia
Unsupervised use of antibiotics threatens the global fight against antimicrobial resistance.

A new survey of citizens in 14 WHO member states in the Balkans, Caucasus and Central Asia found that one third of respondents questioned said that their last course of antibiotics was obtained with a medical prescription.

This is at least three times more than that reported from a similar survey of 30 European Union and European Economic Area member states, in a recent survey of citizens by the European Commission, said WHO’s European Regional Office in a report of the findings issued on Monday, which marks the start of World Antimicrobial Awareness Week.

The findings were part of a wider survey of knowledge, attitudes and behaviour around antimicrobial resistance, (AMR), conducted for the first time ever in the eastern part of the WHO European Region, including the Caucasus and Central Asia.

The countries surveyed included: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, Tajikistan, Turkiye and Uzbekistan.

The findings highlight the wide gap that exists not only worldwide, but within WHO’s sprawling European Region, regarding the use of antibiotics and awareness about growing antimicrobial resistance to common drugs.

WHO’s European Region includes some 53 member states, representing a wide spectrum of economic development levels – also reflective of global development gaps more broadly.  It includes all of the EU/EEA member states as well as member states of the former Soviet Union and other former eastern bloc countries, which are not EU members.

In the WHO survey, one in three respondents said that in their last antibiotics course, they either used leftover antibiotics from a previous prescription or obtained them without a prescription over the counter from a pharmacy or elsewhere, according to the preliminary survey findings.

In addition, 50% of those surveyed across participating countries reported having used antibiotics in the last year, which is more than double that reported for EU/EEA countries for the same period.

Central and Eastern Europe and Central Asia among AMR hotspots worldwide

Number of all-age MRSA deaths attributable to AMR.

At least 1.27 million deaths per year are directly attributable to superbug resistance to common antibiotics, according to global AMR estimates released earlier this year by the Seattle, USA-based Institute for Health Metrics Evaluation (IHME) and the Global Research on Antimicrobial Resistance (GRAM) Project partners.

The deadliest pathogen-drug combination globally was methicillin-resistant Staphylococcus aureus (MRSA), which caused more than 100,000 deaths attributable to AMR in 2019, according to the IHME report. On the GBD super-region level, the number of all-age MRSA deaths attributable to AMR is largest in the Southeast Asia, East Asia, and Oceania super-region and is smallest in the Central Europe, Eastern Europe, and Central Asia super-region.

Deaths from all-age MRSA attributable to AMR are, however, largest in Southeast Asia, East Asia, and the Oceania super-region, the IHME study found, while they are proportionately smallest in Central Europe, Eastern Europe, and Central Asia super-region – where access to health care is still more robust.  Even so, according to WHO, some 35,000 people die from AMR-related infections in the EU/EEA region which represents Europe’s most developed economies.

Slow tsunami on the horizon

WHO Press Technical Briefing 11 July 2022.

“When antibiotic drugs are used too much, for too long or when they are not necessary, bacteria can become resistant to them,” said Dr Danilo Lo Fo Wong, WHO European Regional Adviser for the Control of Antimicrobial Resistance. “Without collective action, we can expect a future in which otherwise treatable illnesses, such as urinary tract infections, could once again become untreatable and procedures such as surgeries or chemotherapy too dangerous to perform.”

In the survey of 61% of respondents were also unaware that antibiotics do not work against viruses, while over half believed, incorrectly, that they were effective against colds. In the EU/EEA region, about 50% of those surveyed mistakenly believed that antibiotics kill viruses.

However, two thirds of respondents said that they understood that unnecessary use of antibiotics made them ineffective.

“Antibiotics cannot cure the common cold. A common cold is caused by a virus, against which antibiotics do not work,” stressed Dr Danilo Lo Fo Wong. “Though antibiotics will not help you, their use may lead to the development of antibiotic resistance and become a problem for you and for someone else.”

WHO Regional Director for Europe, Dr Hans Kluge, called AMR “the slow tsunami building up on the horizon.  We can take steps to make sure that people are informed about their medicines,”

See this link for more about World Antimicrobial Awareness Week events.  Link here for more WHO Resources and a joint campaign of the Quadripartite – including the global agencies dealing with animal health, agriculture and the environment.

Image Credits: Emily Brown,

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