As one of the most important discoveries of mankind, antibiotics play a critical role in the treatment of diseases. However, overuse has led to antimicrobial resistance (AMR), a complex issue of global concern. The World Health Organization (WHO) and the Organization for Economic Co-operation and Development (OECD) defines AMR as the problem of microorganisms developing resistance to antimicrobials they are exposed to. This results in less treatable illnesses. The OECD underlines that the misuse of antibiotics in the medical, veterinary and agricultural sectors, which include the inappropriate prescribing of antibiotics, their overuse in the livestock sector and insufficient hygiene practices in hospitals, all contribute to the rise of AMR. Additionally, global trade and travel have also accelerated its occurrence.
AMR has led to significantly higher burdens on health care systems. Hospitals spend, on average, an additional $10,000 to $40,000 to treat a patient infected by resistant bacteria, according to the OECD. Social costs may be as high as health care costs due to loss of productivity and income. More worryingly, the OECD said with the rise of AMR, we are now heading toward a "post-antibiotic era" where common infections may become, once again, fatal. Despite the lack of sufficient research, academics say that the rise of AMR may be reversible by reducing inappropriate and overuse of antimicrobials.
Turkey is plagued with excessive antibiotic usage: It is the first among 42 countries in antibiotics consumption and second in antimicrobial resistance among 22 countries. The OECD statistics show that, as of 2014, 42 percent of all drugs prescribed in the country have consisted of antibiotics. This is two-times higher than the OECD average of 21 percent and four-times higher than the Netherlands' average of 11 percent. Turkey is followed by Greece's 35 percent and Korea's 32 percent antibiotics consumption. Excessive use of health care services in Turkey is one factor in the overuse of antibiotics. These striking figures are partially due to the expansion in health care services in the recent decades. In 2002, patients in Turkey averaged two consultations with doctors annually, the worst among OECD countries. This number significantly rose over the years to reach 8.4 by 2015, according OECD data. Unofficial statistics say that this rate has already exceeded 10 in 2018.
Yet, there is also a cultural issue here. Many Turkish patients believe the only way to heal is to take antibiotics. Patients want antibiotic prescriptions from their physicians, and some even demand them from pharmacists without prescriptions. As health literacy is low in the country, people tend to use antibiotics like painkillers, while antimicrobials are even used for viral infections, like the common cold. The use of an unfinished box of medicine from a previous illnesses and use under or over the doctor's recommended dosage are also common problems.
Additionally, as transnational pharmaceutical companies encourage prescription drug use — often through unethical methods — the scope of the problem has continued to grow. The Social Security Institution (SSI) had a budget of close to TL 30 billion ($6.65 billion) for medicinal expenses in 2017. According to SSI statistics, the share of antibiotics in total pharmaceutical drug expenditures was 7.38 percent in 2016, with around 250 million boxes of antibiotics prescribed annually. This huge market only works to increase the appetite of multinational pharmaceutical companies.
The Health Ministry has launched a high-profile campaign aimed at promoting the effective use of antimicrobials, controlling prescriptions of these drugs and increasing health literacy to fight against chronic overuse. With posters, brochures, billboards, websites and TV spots, and with ambitious projects built on public-private partnerships, the campaign has been effective in spreading awareness and educating citizens with the slogan: "Insist on your health, not an antibiotic prescription."
The campaign is designed to raise public awareness on three basic rules: Follow the dose and frequency carefully; be sure to finish the prescription, even if you feel better after a few days; and do not use leftover antibiotics. The campaign also involves educational visits to schools. Moreover, physicians often receive incentives for prescribing more antibiotics.
Overall, the government of Turkey is well aware of the problem and has stepped up to find a solution. Although this is a good start, Turkey has a long way to go to ensure the smart use of antimicrobials in Turkish society. After all, widespread cultural problems cannot be solved in a day. The government needs to increase research and development in the antibiotic sector, which would also support domestically produced pharmaceutics, and help the country narrow its high foreign trade deficit.
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