Air pollution and antibiotic resistance are two of the biggest public health challenges globally: together, they cause more than 10 million premature deaths worldwide annually, a figure that is continuously increasing. Air pollution by PM₁₀, PM_2.5 and NO₂ particles is a risk factor for diseases like dementia, certain cancers and respiratory conditions. On the other hand, the excessive or incorrect use of antibiotics ends up triggering the appearance of resistant bacteria, causing infections that cannot be treated. This phenomenon alone is estimated to cause 10 million deaths globally on 2050. The main reason for antibiotic prescription in primary care is acute respiratory infections, although in some cases the diagnosis is wrong and they are actually viral infections or other non-infectious conditions.

Now, a research group from IDIBELL, Bellvitge Hospital and CIBERINFEC has just published in JAMA Network Open the first article linking these two phenomena: based on a complete statistical analysis, scientists have found that on those days when air pollution increases the most, more antibiotics are prescribed. In the case of PM2.5, a delayed association has also been found between the 7th and 10th day after exposure. For this study, they have collected daily data on PM₁₀, PM_2.5 and NO₂ air pollution indicators and antibiotic prescriptions for respiratory conditions in primary care centers in the 11 most populous Catalan cities, over 8 years.

According to Dr. Jordi Carratalà, leader of the study, 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 pollutant particles.”

A global health problem

In any case, this study, which has included around 1.9 million inhabitants and more than 8 million antibiotic prescriptions in primary care, represents 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 implement more ambitious environmental policies aimed at improving air quality and reducing the burden of respiratory diseases as well as the excessive use of antibiotics. In addition, as this is the first publication on the subject, it is necessary to continue doing similar research in different geographical regions of the world to confirm and expand the results.

The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.

IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).