NEW YORK, Aug 13 (Reuters) -- A nationwide campaign in Finland to reduce antibiotic-resistant bacteria seems to be working, cutting in half the percentage of resistant streptococcus over a period of only five years.
The campaign was launched in 1991, after it was found that 16% of group A streptococcal bacteria -- which can cause sore throat, tonsillitis, scarlet fever, rheumatic fever, and pneumonia -- were resistant to erythromycin, the drug most commonly used if a person is allergic to penicillin.
By 1996, the number of erythromycin-resistant bacteria had dropped to 8.6% after a nationwide campaign to reduce the use of erythromycin and similar antibiotics for the treatment of respiratory and skin infections, according to a report in The New England Journal of Medicine.
The finding suggests that informing doctors about the risk of antibiotic-resistant bacteria is "important in the battle against antibiotic-resistant bacteria," wrote Dr. Helena Seppala, of the Antimicrobial Research Laboratory at the National Public Health Institute in Turku, Finland.
Antibiotic-resistant bacteria are a serious and ongoing problem, costing millions in the treatment of illness, as well as the development of new drugs to combat the resistant bugs. Overuse of antibiotics is a major reason that such resistance develops in bacteria, including the use of the drugs in animal feed or to treat viral illnesses. Antibiotics are useless in treating viruses that cause colds, sore throat, or respiratory diseases.
"Antibacterial drugs are powerful weapons when used reasonably against infectious targets, but when they are imprudently prescribed for nonspecific symptoms or infection that is probably viral, their use may only contribute to bacterial resistance," wrote Dr. Morton Swartz in an editorial accompanying the study. "This applies to the use of antimicrobial agents in hospitals, in the community and in animal feedlots," according to Swartz, a physician at the Massachusetts General Hospital in Boston.
According to the report, doctors were informed of the problem mainly through the Finnish Medical Journal and lectures at national and local meetings, and the campaign was "surprisingly effective." The consumption of erythromycin and similar antibiotics -- known as macrolide antibiotics -- were halved from 2.4 doses per 1000 inhabitants per day in 1991 to 1.4 doses in 1992. Pharmaceutical companies accepted the recommendations, according to the researchers, and testing of throat swabs and pus cultures revealed that group A streptococcal resistance dropped by half by 1996.
"This is an impressive example of how an enlightened national policy on antibiotic use can become an effective public health measure," Swartz said. However, the problem is far from over. The use of newer macrolide drugs, such as roxithromycin and azithromycin may cause resistance to go back up again, according to the report.
"Since there is cross-resistance among erythromycin, roxithromycin, clarithromycin, and azithromycin, the newer macrolides may well select for resistance," the authors noted.
SOURCE: The New England Journal of Medicine (1997;337:441-446, 491-492)
