Belgium aims to reduce antibiotics prescriptions

Belgium aims to reduce antibiotic prescriptions by general practitioners by 40%, as international health organisations warn of growing resistance that is outpacing pharmaceutical innovation.

While resistant infections are on the rise in many parts of the world, Belgium is seeing a significant drop in antibiotic consumption for the first time in several years.

While encouraging, the country still lags behind when it comes to ambitious targets set at European and national level.

In some parts of the world, treatment options are becoming scarce due to antibiotic resistance, raising fears of a return to the pre-antibiotic era when common infections would once again become dangerous.

At the same time, pharmaceutical innovation is slow and truly effective new treatments remain too rare.

Thanks to long-standing surveillance and rationalisation policies, Europe is coping better than other regions. But despite this general stabilisation, several member states, including Belgium, are starting from a historically high level of consumption.

“In the ranking of countries that consume the most antibiotics, Belgium is at the top,” said Pedro Facon, a specialist in rational antibiotic use policies at the National Institute for Health and Disability Insurance (Inami).

The country has set objectives that include a 40% reduction in first-line use - generally from GPs - and a reduction in hospital settings as well.

“These are ambitious goals, but they are absolutely necessary,” Facon said, noting that the last 10 years showed an overall positive trend, particularly during the Covid period when distancing measures reduced the spread of common infections, automatically leading to a decline in prescriptions.

“After this period, usage increased slightly, but over the last 12 months, we have seen a decrease of nearly 10% in overall antibiotic use, and above all a significant decrease in second-line antibiotics.”

Second-line antibiotics are antibiotics used when first-line antibiotics prove ineffective.

To achieve its objectives, Belgium is relying on a collective effort involving the health ministry, public health institute Sciensano and the Inami. The strategy is based on three levers: the production of recommendations, the setting of indicators and personalised feedback to prescribers.

“We have put guidelines in place for doctors and set indicators, which allows prescribers to position themselves in relation to their colleagues,” said Facon.

In concrete terms, each doctor receives regular feedback on their prescriptions, with a level of detail that allows them to compare their practice with that of doctors working in a similar context.

For the time being, the approach is mainly based on raising awareness, but the prospect of a more binding component is becoming clearer.

“It is not coercive at the moment,” warned Facon.

“Those who continue to over-prescribe will be closely monitored and sanctioned. There is a threshold for justification, a quantified target.

"We always give the prescriber the opportunity to justify themselves. Prescribing practices can vary greatly depending on the patient population, sector and region."

Despite the recent decline, Belgium remains far from its targets: the use of antibiotics in primary care remains high, particularly for viral infections where they are of no benefit. In hospitals, certain nosocomial bacteria are showing increasing resistance – an indicator that progress remains fragile.

Experts also stress that the observed decline must be interpreted with caution. A single winter season marked by a resurgence of respiratory infections could reverse the trend, which is why health authorities are insisting on stable changes in practices, increased use of rapid tests and a stronger link between general practitioners and pharmacists.

"We are on the right track," said Facon, "but we are still a long way from our goal".