Kathleen Finlay (Getty Images/Image Source)
To cure his infection, Antonio López needed a seven-day course of antibiotics, three pills a day: a total of 21 tablets.
The medication he was prescribed was only sold in boxes of 20, so the doctor had to prescribe two, which wasted 19 pills.
Not only is it a waste, but these types of medications should not be at home if they are not going to be consumed, because their non-prescription use is contributing to antimicrobial resistance, one of the great threats to public health.
López, who is head of the Infectious Diseases Service of the Spanish Agency for Medicines and Health Products (AEMPS), tells this real anecdote to show that it is necessary to review the way in which this type of medicines are sold.
The National Antibiotic Resistance Plan (PRAN) plans to meet in the coming months to address the issue, which has more edges than perhaps can be seen at first glance.
The problem with antibiotics is that they have been used more than necessary, and often for diseases for which they are not useful, such as viral infections.
Storing leftover doses at home creates two risks: self-medication when the patient notices symptoms similar to when they were prescribed it (certain viruses and bacteria can cause indistinguishable signs) or that they end up being thrown away in inappropriate places.
And both actions contribute to the same thing: these medications lose their effectiveness against the bacteria against which they are designed, since they come into contact with them without killing them, so they mutate and adapt.
A study in 130 Spanish hospitals determined that in 2023, 23,303 people died in the country from this cause.
And the WHO estimates that in 2050 resistance will be more deadly than cancer: if drastic measures are not taken to combat it, by then 10 million people may die every year because of it.
The debate about modifying packaging is not new.
Already in 2012 there was an attempt to better adapt the number of pills per box to the time the treatments usually last.
Although some containers with a single dose were even marketed, they were discontinued due to lack of use.
Other formats of different sizes were also created and waste was reduced by approximately 15% in the following two years, but there is often still a great disparity between the number of tablets that the patient needs and those that have to be taken home. due to the formats in which they are marketed.
Last year, the European Commission warned member countries to review packaging formats and better adapt them to treatment needs with the aim of continuing to reduce the use of drugs: Spain is the fifth state with the most consumes, and although there has been a 25.5% reduction in humans since 2014, Europe calls for an additional 27% increase until 2030. And this is what the AEMPS will study, together with scientific societies and the pharmaceutical industry.
Individual boxes and loose pills
Several options open up.
“We are not going with a predetermined idea,” says López.
“Blisters could be made again with a single tablet and its leaflet, but this has high production costs and the system would have to be willing to assume that cost,” he explains.
The possibility of selling pills loose, as happens in several Anglo-Saxon countries, is also on the table, but the system would have to be adapted.
“Right now he is not prepared to do it.
The agency guarantees that medicines are put on the market with a certain quality.
Pharmacists could select them, but the procedures would have to be changed to ensure guarantees and traceability,” López continues.
The person in charge of the AEMPS doubts that the scientific evidence that exists regarding the improvement with this procedure makes such an adaptation worthwhile.
Therefore, to make decisions it is necessary to make an analysis of which are the most indicated treatments, which are the dispensations, and what differences there usually are between them.
Boxes of antibiotics in a pharmacy in Madrid.
Samuel Sanchez
In certain cases, when the difference between what is in a box and the treatment is minimal (for example, a tablet, as happened to López), some specialists are committed to simplifying the process.
“The human body is not mathematical and treatment monitoring is not done strictly.
If there are ideally 21 tablets and the box is 20, the patient can be told to finish it with three doses a day, and if one dose is not taken there will be no difference in the cure,” a pharmacist pointed out in a forum. on antimicrobial resistance organized last month in Madrid by Alliance Healthcare.
Because the industry argues that changing packaging formats poses logistical challenges for medicines that have little profit margin.
Emili Esteve, spokesperson for Farmaindustria, believes that it would not make much sense for Spain to stand out and adopt different formats from its surrounding countries.
“Many times these medicines are produced in global plants and what companies want is for all the blister packs to have the same alveoli.
If you make them with 10 and a country comes to you that wants seven, the company has to consider what it does in that country,” reasons Esteve, who is waiting to start conversations with the AEMPS to find solutions.
The Nordic countries already have different formats than the majority of Europe that try to adapt better to standard treatments.
But, whatever the presentation, it is impossible for it to be valid for all types of infections, since each one usually requires different doses.
López suggests that awareness and mechanisms to return leftover doses to pharmacies can also be part of the strategy to reduce antibiotic abuse.
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