Call for caution over antibiotics overuse in Belgium

Belgium must stop doling out so many prescriptions for antibiotics, the country’s health insurance body Inami has warned.

It says that by 2025, the aim is to decrease antibiotics use by 43%. This measure is essential, as the consequences of antibiotics use are significant.

Every year, more than 35,000 people in Europe die from an infection caused by antibiotic-resistant bacteria.

The health impact in Europe of such resistance is therefore as great as that of influenzas, tuberculosis and HIV/Aids combined.

Inami sent a letter earlier this month to all general practitioners in Belgium who have prescribed antibiotics to their patients over the last five years.

This tells the doctor how often they have prescribed these drugs and if they have complied with the relevant guidelines.

This missive is only the first step. In a year’s time, if doctors still prescribe antibiotics too often, they will have to explain why, Inami has warned.

Those who cannot provide a valid explanation risk an official sanction which could range from a warning to needing to reimburse patients who bought the wrongly-prescribed antibiotics. If the fault is seen as intentional, these doctors risk a fine.

The national health insurance institute’s plan is to notify GPs how they use prescriptions for antibiotics. The three indicators are: if they prescribe too many; how often they offer standard antibiotics; and, how often they use antibiotics that are not recommended.

According to 2019 Inami statistics, Belgian GPs prescribe antibiotics to seven out of 10 people they see.

Woluwe-Saint-Lambert GP Dimitri Ivlef told RTL there are many reasons for increased antibiotics use in 2024 than in previous years.

"Firstly, there’s this virus that’s endemic: Covid," he said. "And we don’t prescribe antibiotics for Covid but for super-infections [a second infection triggered by a very similar pathogen] after Covid. Secondly, we have had very wet weather with lots of flowering, so there have been high levels of pollenisation and attacks on the sinuses.”

Many super-infections can only be treated with antibiotics, Ivlef said. So rather than Inami imposing blanket punishments or even fines on doctors using them, they should "come to the front line, to see what is really happening, to observe how we tackle these problems", he said.

"After nine years’ study, if we are not able to determine if an antibiotic is necessary or not, there is clearly a problem."

In general, doctors’ reaction to Inami’s plans are mixed. In Brussels, Dr Hanna Ballout told RTL that in the end they were not forced to meet the new rules.

Faced with potential sanctions, many doctors are planning to meet to protest against these measures if Inami goes ahead with its plan.