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In Greece antibiotics must be prescribed by medical doctors. Recipes
are executed by qualified private sector Pharmacists.
The number of Pharmacies in Greece has risen to many thousands in
recent years, so competition is very high!
Many patients choose to bypass the fee to the medical doctor and
decide to self-medicate empirically. Some even buy more pills than their
doctor has prescribed!
In a free, highly competitive market, Pharmacists are forced to
administer the antibiotics asked. If they choose to refuse presenting
ethical arguments, patients will simply buy their pills in the Pharmacy
down the road! [6]
Over the last years, all studies demonstrate an increasing use of
antibiotics by the population and an even more increasing microbe
resistance to many antibiotics.
[1][2][4][5][7][8][9][11][12][13][14][15][16][17][18]
>60% resistance to quinolones, [2] is a quality even biological
warfare laboratories would envy!
Multi-resistant isolates are even found in hydrotherapy pools!
[3][10]
Clearly, the Department of drug vigilance of the Ministry of Health
must urgently decide on restrictive measures and apply them efficiently.
[1] Fusidic acid and clindamycin resistance in community-associated,
methicillin-resistant Staphylococcus aureus infections in children of
Central Greece.
Katopodis GD, Grivea IN, Tsantsaridou AJ, Pournaras S, Petinaki E,
Syrogiannopoulos GA.
BMC Infect Dis. 2010 Dec 13;10:351.
[2] Resistance status and evolution trends of Klebsiella pneumoniae
isolates in a university hospital in Greece: ineffectiveness of
carbapenems and increasing resistance to colistin.
Neonakis IK, Samonis G, Messaritakis H, Baritaki S, Georgiladakis A,
Maraki S, Spandidos DA.
Chemotherapy. 2010;56(6):448-52. Epub 2010 Nov 18.
[3] Prevalence and antibiotic resistance of Pseudomonas aeruginosa
isolated from swimming pools in northern Greece.
Tirodimos I, Arvanitidou M, Dardavessis L, Bisiklis A, Alexiou-Daniil S.
East Mediterr Health J. 2010 Jul;16(7):783-7.
[4] Serotype distribution and antimicrobial resistance of adult
Streptococcus pneumoniae clinical isolates over the period 2001-2008 in
Crete, Greece.
Maraki S, Mantadakis E, Samonis G.
Chemotherapy. 2010;56(4):325-32. Epub 2010 Aug 17.
[5] Trends in antimicrobial resistance of clinical isolates of
Enterococcus faecalis and Enterococcus faecium in Greece between 2002 and
2007.
Protonotariou E, Dimitroulia E, Pournaras S, Pitiriga V, Sofianou D,
Tsakris A.
J Hosp Infect. 2010 Jul;75(3):225-7. Epub 2010 Apr 8.
[6] Dispensing of antibiotics without prescription in Greece, 2008:
another link in the antibiotic resistance chain.
Plachouras D, Kavatha D, Antoniadou A, Giannitsioti E, Poulakou G,
Kanellakopoulou K, Giamarellou H.
Euro Surveill. 2010 Feb 18;15(7). pii: 19488.
[7] Occurrence, virulence genes and antibiotic resistance of
Escherichia coli O157 isolated from raw bovine, caprine and ovine milk in
Greece.
Solomakos N, Govaris A, Angelidis AS, Pournaras S, Burriel AR, Kritas SK,
Papageorgiou DK.
Food Microbiol. 2009 Dec;26(8):865-71. Epub 2009 Jun 10.
[8] Moxifloxacin resistance is prevalent among Bacteroides and
Prevotella species in Greece.
Papaparaskevas J, Pantazatou A, Katsandri A, Houhoula DP, Legakis NJ,
Tsakris A, Avlamis A.
J Antimicrob Chemother. 2008 Jul;62(1):137-41. Epub 2008 Apr 1.
[9] Antimicrobial resistance of Esherichia coli urinary isolates from
primary care patients in Greece.
Falagas ME, Polemis M, Alexiou VG, Marini-Mastrogiannaki A, Kremastinou J,
Vatopoulos AC.
Med Sci Monit. 2008 Feb;14(2):CR75-79.
[10] Microbiological quality of indoor and outdoor swimming pools in
Greece: investigation of the antibiotic resistance of the bacterial
isolates.
Papadopoulou C, Economou V, Sakkas H, Gousia P, Giannakopoulos X, Dontorou
C, Filioussis G, Gessouli H, Karanis P, Leveidiotou S.
Int J Hyg Environ Health. 2008 Jul;211(3-4):385-97. Epub 2007 Aug 28.
[11] Antimicrobial resistance of urinary tract pathogens in
children in Crete, Greece.
Anatoliotaki M, Galanakis E, Schinaki A, Stefanaki S, Mavrokosta M,
Tsilimigaki A.
Scand J Infect Dis. 2007;39(8):671-5.
[12] Trends in antimicrobial resistance of Acinetobacter baumannii
clinical isolates from hospitalised patients in Greece and treatment
implications.
Falagas ME, Mourtzoukou EG, Polemis M, Vatopoulos AC; Greek System for
Surveillance of Antimicrobial Resistance.
Clin Microbiol Infect. 2007 Aug;13(8):816-9.
[13] Nationwide surveillance of Streptococcus pneumoniae in Greece:
patterns of resistance and serotype epidemiology.
Poulakou G, Katsarolis I, Matthaiopoulou I, Tsiodras S, Kanavaki S,
Hatzaki D, Roilides E, Sofianou D, Kavaliotis I, Kansouzidou A, Kafetzis
DA, Paraskakis I, Foustoukou M, Daikos GL, Syriopoulou V, Pangalis A,
Leveidiotou S, Giamarellou H; Hellenic Study Group for the Susceptibility
of Streptococcus pneumoniae.
Int J Antimicrob Agents. 2007 Jul;30(1):87-92. Epub 2007 May 30.
[14] Evolution of resistance patterns and identification of risk
factors for Streptococcus pneumoniae colonisation in daycare centre
attendees in Athens, Greece.
Volonakis K, Souli M, Kapaskelis A, Baziaka F, Grammelis V, Ziakas PD,
Giamarellou H.
Int J Antimicrob Agents. 2006 Oct;28(4):297-301. Epub 2006 Sep 7.
[15] Serotype distribution and antimicrobial resistance of
Salmonella enterica from patients with gastroenteritis in Crete, Greece.
Maraki S, Samonis G, Mantadakis E, Nioti E, Tselentis Y.
Eur J Clin Microbiol Infect Dis. 2006 Feb;25(2):116-9.
[16] Antimicrobial resistance of Streptococcus pneumoniae isolates in
Athens, Greece.
Kanavaki S, Mantadakis E, Karabela S, Anatoliotaki M, Makarona M, Moraitou
H, Pefanis A, Samonis G.
Eur J Clin Microbiol Infect Dis. 2005 Oct;24(10):693-6.
[17] Quinolone resistance among Escherichia coli strains from
community-acquired urinary tract infections in Greece.
Chaniotaki S, Giakouppi P, Tzouvelekis LS, Panagiotakos D, Kozanitou M,
Petrikkos G, Avlami A, Vatopoulos AC; WHONET Study Group.
Clin Microbiol Infect. 2004 Jan;10(1):75-8.
[18] A 5-year study of the bacterial pathogens associated with acute
diarrhoea on the island of Crete, Greece, and their resistance to
antibiotics.
Maraki S, Georgiladakis A, Tselentis Y, Samonis G.
Eur J Epidemiol. 2003;18(1):85-90.
Competing interests:
No competing interests
09 June 2011
Stavros Saripanidis
Consultant in Obstetrics and Gyneacology in Greece
Alarming trends of resistance to antibiotics in Greece.
Dear Editor,
In Greece antibiotics must be prescribed by medical doctors. Recipes
are executed by qualified private sector Pharmacists.
The number of Pharmacies in Greece has risen to many thousands in
recent years, so competition is very high!
Many patients choose to bypass the fee to the medical doctor and
decide to self-medicate empirically. Some even buy more pills than their
doctor has prescribed!
In a free, highly competitive market, Pharmacists are forced to
administer the antibiotics asked. If they choose to refuse presenting
ethical arguments, patients will simply buy their pills in the Pharmacy
down the road! [6]
Over the last years, all studies demonstrate an increasing use of
antibiotics by the population and an even more increasing microbe
resistance to many antibiotics.
[1][2][4][5][7][8][9][11][12][13][14][15][16][17][18]
>60% resistance to quinolones, [2] is a quality even biological
warfare laboratories would envy!
Multi-resistant isolates are even found in hydrotherapy pools!
[3][10]
Clearly, the Department of drug vigilance of the Ministry of Health
must urgently decide on restrictive measures and apply them efficiently.
[1] Fusidic acid and clindamycin resistance in community-associated,
methicillin-resistant Staphylococcus aureus infections in children of
Central Greece.
Katopodis GD, Grivea IN, Tsantsaridou AJ, Pournaras S, Petinaki E,
Syrogiannopoulos GA.
BMC Infect Dis. 2010 Dec 13;10:351.
[2] Resistance status and evolution trends of Klebsiella pneumoniae
isolates in a university hospital in Greece: ineffectiveness of
carbapenems and increasing resistance to colistin.
Neonakis IK, Samonis G, Messaritakis H, Baritaki S, Georgiladakis A,
Maraki S, Spandidos DA.
Chemotherapy. 2010;56(6):448-52. Epub 2010 Nov 18.
[3] Prevalence and antibiotic resistance of Pseudomonas aeruginosa
isolated from swimming pools in northern Greece.
Tirodimos I, Arvanitidou M, Dardavessis L, Bisiklis A, Alexiou-Daniil S.
East Mediterr Health J. 2010 Jul;16(7):783-7.
[4] Serotype distribution and antimicrobial resistance of adult
Streptococcus pneumoniae clinical isolates over the period 2001-2008 in
Crete, Greece.
Maraki S, Mantadakis E, Samonis G.
Chemotherapy. 2010;56(4):325-32. Epub 2010 Aug 17.
[5] Trends in antimicrobial resistance of clinical isolates of
Enterococcus faecalis and Enterococcus faecium in Greece between 2002 and
2007.
Protonotariou E, Dimitroulia E, Pournaras S, Pitiriga V, Sofianou D,
Tsakris A.
J Hosp Infect. 2010 Jul;75(3):225-7. Epub 2010 Apr 8.
[6] Dispensing of antibiotics without prescription in Greece, 2008:
another link in the antibiotic resistance chain.
Plachouras D, Kavatha D, Antoniadou A, Giannitsioti E, Poulakou G,
Kanellakopoulou K, Giamarellou H.
Euro Surveill. 2010 Feb 18;15(7). pii: 19488.
[7] Occurrence, virulence genes and antibiotic resistance of
Escherichia coli O157 isolated from raw bovine, caprine and ovine milk in
Greece.
Solomakos N, Govaris A, Angelidis AS, Pournaras S, Burriel AR, Kritas SK,
Papageorgiou DK.
Food Microbiol. 2009 Dec;26(8):865-71. Epub 2009 Jun 10.
[8] Moxifloxacin resistance is prevalent among Bacteroides and
Prevotella species in Greece.
Papaparaskevas J, Pantazatou A, Katsandri A, Houhoula DP, Legakis NJ,
Tsakris A, Avlamis A.
J Antimicrob Chemother. 2008 Jul;62(1):137-41. Epub 2008 Apr 1.
[9] Antimicrobial resistance of Esherichia coli urinary isolates from
primary care patients in Greece.
Falagas ME, Polemis M, Alexiou VG, Marini-Mastrogiannaki A, Kremastinou J,
Vatopoulos AC.
Med Sci Monit. 2008 Feb;14(2):CR75-79.
[10] Microbiological quality of indoor and outdoor swimming pools in
Greece: investigation of the antibiotic resistance of the bacterial
isolates.
Papadopoulou C, Economou V, Sakkas H, Gousia P, Giannakopoulos X, Dontorou
C, Filioussis G, Gessouli H, Karanis P, Leveidiotou S.
Int J Hyg Environ Health. 2008 Jul;211(3-4):385-97. Epub 2007 Aug 28.
[11] Antimicrobial resistance of urinary tract pathogens in
children in Crete, Greece.
Anatoliotaki M, Galanakis E, Schinaki A, Stefanaki S, Mavrokosta M,
Tsilimigaki A.
Scand J Infect Dis. 2007;39(8):671-5.
[12] Trends in antimicrobial resistance of Acinetobacter baumannii
clinical isolates from hospitalised patients in Greece and treatment
implications.
Falagas ME, Mourtzoukou EG, Polemis M, Vatopoulos AC; Greek System for
Surveillance of Antimicrobial Resistance.
Clin Microbiol Infect. 2007 Aug;13(8):816-9.
[13] Nationwide surveillance of Streptococcus pneumoniae in Greece:
patterns of resistance and serotype epidemiology.
Poulakou G, Katsarolis I, Matthaiopoulou I, Tsiodras S, Kanavaki S,
Hatzaki D, Roilides E, Sofianou D, Kavaliotis I, Kansouzidou A, Kafetzis
DA, Paraskakis I, Foustoukou M, Daikos GL, Syriopoulou V, Pangalis A,
Leveidiotou S, Giamarellou H; Hellenic Study Group for the Susceptibility
of Streptococcus pneumoniae.
Int J Antimicrob Agents. 2007 Jul;30(1):87-92. Epub 2007 May 30.
[14] Evolution of resistance patterns and identification of risk
factors for Streptococcus pneumoniae colonisation in daycare centre
attendees in Athens, Greece.
Volonakis K, Souli M, Kapaskelis A, Baziaka F, Grammelis V, Ziakas PD,
Giamarellou H.
Int J Antimicrob Agents. 2006 Oct;28(4):297-301. Epub 2006 Sep 7.
[15] Serotype distribution and antimicrobial resistance of
Salmonella enterica from patients with gastroenteritis in Crete, Greece.
Maraki S, Samonis G, Mantadakis E, Nioti E, Tselentis Y.
Eur J Clin Microbiol Infect Dis. 2006 Feb;25(2):116-9.
[16] Antimicrobial resistance of Streptococcus pneumoniae isolates in
Athens, Greece.
Kanavaki S, Mantadakis E, Karabela S, Anatoliotaki M, Makarona M, Moraitou
H, Pefanis A, Samonis G.
Eur J Clin Microbiol Infect Dis. 2005 Oct;24(10):693-6.
[17] Quinolone resistance among Escherichia coli strains from
community-acquired urinary tract infections in Greece.
Chaniotaki S, Giakouppi P, Tzouvelekis LS, Panagiotakos D, Kozanitou M,
Petrikkos G, Avlami A, Vatopoulos AC; WHONET Study Group.
Clin Microbiol Infect. 2004 Jan;10(1):75-8.
[18] A 5-year study of the bacterial pathogens associated with acute
diarrhoea on the island of Crete, Greece, and their resistance to
antibiotics.
Maraki S, Georgiladakis A, Tselentis Y, Samonis G.
Eur J Epidemiol. 2003;18(1):85-90.
Competing interests: No competing interests