Declaration of the WTO on the responsible consumption of antibiotics.

Spain is one of the developed world with the highest consumption of antibiotics (35 daily doses definidas/1.000 inhabitants / day). For years there has been a gradual increase in bacteria resistant to treatment. This problem is of global significance as globalization increases the vulnerability of any country to which diseases are present in other, and in the same way, resistant bacteria travel, which is a serious threat to global public health, as the WHO.

Resistant bacterial infections are associated with increased morbidity, mortality, health care demand, health spending and the deterioration of the effectiveness of treatment for future patients, which is probably conditioned that infectious diseases are the most frequent cause of consultation (40% visits to primary care).

The doctor performs the prescription data on knowledge of bacterial resistance in the center that works, there is no self-control and the clinical course and treatment compliance on a daily basis. Aspects that should be enhanced in primary care where there is a supply of antibiotics more than 1,000 pharmaceutical products.

The excessive consumption of antibiotics in primary care is driven by lack of rationality in the prescription, the prescription drug dispensing, the indiscriminate use made by patients and lack of clear initiatives for the health authorities to develop a policy of antibiotics in primary care to improve their use.


DOCTORS:


1. They should remember that the etiology of many of the infections treated at primary care is not necessarily of bacterial origin and that, including those enrolled in patients without co-morbidities, may be localized and self-limiting, ie that can cure without antibiotic treatment.


2. Always, before an infectious process:
a) Confirm the existence of infection.
b) Locate the infection.
c) Select the drug with a pharmacokinetic and pharmacodynamic properties that support its activity in a given location of the body, maintaining the proper concentration in the outbreak of the infection.
d) Knowing the area of bacterial resistance.
e) Determine the need for antibiotic treatment.
f) Choose the most effective antibiotic with narrower spectrum of bacterial activity.
g) To administer the antibiotic at the correct dosage, the right time, for the right way, following up to verify their therapeutic effect.
h) Adequate antibiotic treatment to the patient (allergies, age, weight, renal and hepatic function, pregnancy, history of recent hospitalization or surgery).
i) Inform the patient about the infection and treatment prescribed, emphasizing the importance of adhering to the recommended dose and duration of treatment.
j) Monitor compliance, possible that adverse effects and assess the effectiveness of treatment.

3. Consult guides treatment and good clinical practice to date, independent, evidence-based.

4. Promote and develop programs and policies for the rational use of antibiotics with multidisciplinary.



Pharmacists:


1. Must comply with the law and not dispense any prescription without appropriate antibiotic prescribed by your doctor. The timing of delivery should use to set up educational strategies to improve knowledge about antibiotics, and lower self-educating the population, highlighting the need for a medical examination and a clinical diagnosis prior a prescription.

2. With physicians to promote the correct use of antibiotics

3. Participate in programs and policies for the rational use of antibiotics. Pharmacies in health facilities are the ideal place to convey educational messages on health, previously developed by the team of health professionals.

4. Report on the importance of compliance, dosage and duration of treatment prescribed by doctors, and make sure the patient has understood.


HEALTH ADMINISTRATION:

1. Improve conditions in health care, give the doctor time and
tools needed to make good use of antibiotics.

2. Inspection in an efficient dispensing of antibiotics without prescription
Offices in Pharmacy.

3. Discourage the use of antibiotics for hospital use and new
supposedly innovative formulas.

4. Homogenize specialty pharmaceutical patterns more
common duration of treatment of various infectious processes.

5. Efficient control of advertising campaigns in the industry
pharmaceutical, enforcing existing laws, and according to the data sheet.

6. Inform the public about the consequences of self.

7. Enable protocol and policies to implement antimicrobial therapy in different situations and epidemics, with multidisciplinary and led by clinical pharmacists, family doctors and pediatricians.

8. Create and develop policies for antibiotics in primary care.

9. Efficient use of antibiotics in veterinary slow its widespread use (representing 40 percent of total consumption of antibiotics in Spain).

10. Monitor the use, application and promotion of antibiotics by the food industry and chemical-pharmaceutical.


This document is intended to recall and reinforce other existing result of consensus among medical and pharmaceutical scientific societies.


Madrid, November 18, 2008

General Council of the Medical Association