Air pollution and antibiotic use

In a revealing new study, air pollution from industrial and vehicle emissions has been linked for the first time to the frequency of antibiotic use.

The study was carried out by a team made up of research staff from the Bellvitge University Hospital (HUB) in Hospitalet de Llobregat, Barcelona; the Bellvitge Biomedical Research Institute (IDIBELL), located in Hospitalet de Llobregat and one of the CERCA institutions of the Generalitat of Catalonia; the Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC); and the Biomedical Research Network Centre for Epidemiology and Public Health (CIBERESP), in Spain. The team is headed by Gabriela Abelenda-Alonso, from the Bellvitge University Hospital, IDIBELL and CIBERINFEC.

This pioneering study demonstrates for the first time that ambient air pollution is associated with increased antibiotic consumption.

Air pollution and antibiotic resistance have become two of the world’s major public health challenges, together causing more than 10 million deaths each year. This alarming number continues to rise. Polluting particles such as PM10, PM2.5 and NO2 have been associated with an increased risk of diseases such as dementia, certain types of cancer and various respiratory conditions. At the same time, excessive or incorrect use of antibiotics contributes to the development of resistant bacteria, which generate infections that are difficult, and often impossible, to treat. It is estimated that by 2050, these infections could cause 10 million deaths per year. The main reason for prescribing antibiotics in primary care is acute respiratory infections, although in some cases the diagnosis is erroneous because they are actually viral infections or other conditions.

To study this, daily data on ambient air pollution and antimicrobial drug consumption in the 11 most populated cities in Catalonia have been analysed over 8 years. After a complete statistical study, researchers have observed that increases in PM10, PM2.5 and NO2 concentrations are associated with an increase in the prescription of antibiotics for acute respiratory symptoms in primary care centres on the same day of exposure to the polluting agents. In the case of PM2.5 particles, a delayed association was also observed between days 7 and 10 after exposure.

Four members of the research team. (Photo: IDIBELL / CIBER)

According to Jordi Carratalà, co-author of the study and group leader at CIBERINFEC, this relationship “could be caused because pollution irritates the respiratory tract and causes symptoms similar to those of an infection, as well as facilitating a secondary bacterial infection that occurs while the immune system is fighting against the polluting particles.”

In any case, the findings of this study, which involved around 1.9 million inhabitants and more than 8 million antibiotic prescriptions in primary care, represent an important step towards understanding the effects of air pollution on public health and adds to the rest of the evidence on the need to adopt more ambitious environmental measures aimed at improving air quality and reducing the burden of respiratory diseases, as well as the excessive use of antimicrobial drugs. Furthermore, as this is the first study of its kind on the subject, there is a need to continue investigating the same phenomenon in different geographical regions of the world and to confirm and expand the results.

The study is titled “Short-Term Exposure to Ambient Air Pollution and Antimicrobial Use for Acute Respiratory Symptoms.” It has been published in the academic journal JAMA Network Open. (Source: IDIBELL / CIBER)