The European Union promotes Happy Patient to investigate patient-doctor strategies to reduce inappropriate antibiotic consumption

  • The World Health Organization warns that in the coming years, a large part of the
    medicines that work today will cease to be effective if the use and prescription of
    antibiotics is not rationalized at all levels of care.
  • It is imperative to implement a successful strategy to reduce the use of antibiotics, which can be tailored and implemented in a wide range of different systems and prescribing cultures. 

Up to 16 scientific, university, and clinical organizations from 8 European countries (Spain,
France, Germany, Poland, Lithuania, Netherlands, Greece, Denmark, and Norway), will develop a European project over the next 3 years to generate studies, research, and training materials in the following target-countries: Spain, France, Greece, Poland, and Lithuania to prevent the incorrect and massive prescription of antibiotics at various levels of care. The start of activities is on the 1 st of January 2021

HAPPY PATIENT aims to set an end to the arbitrary prescription of antibiotics 

The HAPPY PATIENT Project is born as a response from the European Commission to address the growth of antimicrobial resistance (AMR) over the last 20 years. The project argues that «after two decades’ effort in addressing the growth of antimicrobial resistance (AMR), the urgency of the problem is now widely understood. Inappropriate use of antibiotics is the main driver for the growing development and spread of antimicrobial resistance.

Those tasks will aim to produce close collaboration and coordination when responding to the needs and realities of each of the countries represented within the consortium. 

To this end, Primary Care, its professionals, and patients, will be the targeted audience for interventions and for monitoring the effects before and after each intervention. 

Together with doctors and family doctors, nursing professionals, and dentists of the first level of care, Happy Patient will also work with Out hours, nursing homes, and community pharmacies professionals, as well as research centers

The five targeted countries for the project will be Spain, France, Poland, and Greece that hold the highest positions in the European antibiotic consumption statistics, and Lithuania, whose consumption data is at the lowest part of the scope. Happy Patient’s start date is 1st of January 2021, and it will last up to 36 months.


Europe and Antibiotics

The current misleading antibiotics prescription in many European countries is one of the biggest threats to western societies. The WHO Europe Region has been warning in this regard for years, and the SARS-CoV-2 pandemic has not changed its position.

According to the available data provided by the European Centre for Disease Prevention and Control (ECDC), up to 33,000 people die every year in Europe as a direct consequence of the misuse of antibiotics, a figure that rises up to 30,000 in the United States.

The increase in mortality derived from the resistance of microorganisms is reaching alarming levels in many other parts of the world, fueled, among other circumstances, by its massive use in animals and by the industrialization of meat production processes.

The first Survey of HCW’s knowledge, attitudes, and behaviours on antibiotics, antibiotic use, and antibiotic resistance, published in 2019, collected data from 18,000 professionals in 24 EU countries, 75% of whom stated that they did not know in depth the consequences of resistance to antibiotics.


High rates of resistance in urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhea

One of the most important tasks in combating antibiotic resistance is to classify AMR one by one and on a case-by-case basis. For example, common bacterial infections, including urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhea, are known to have high rates of resistance to antibiotics frequently used to treat them around the world. The rate of resistance to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, was found to be between 8.4% and 92.9% in Escherichia Coli and and between 4.1% and 79.4% in Klebsiella pneumoniae, as recently reported by the Global Antimicrobial Resistance and Use Surveillance System (GLASS).

In another order of diseases, antibiotic-resistant Mycobacterium tuberculosis strains are already a very real threat in the progress of containing the global tuberculosis epidemic.

The WHO estimates that, in 2018, there were around half a million new cases of rifampicin-resistant TB (RR-TB) identified globally, of which the vast majority with multi-drug-resistant TB (multi-drug resistant tuberculosis MDR-TB), a form of tuberculosis that has been found to be also resistant to the two most powerful anti-tuberculosis drugs ever created.

Less than 60% of those treated for MDR / RR-TB were successfully cured.


// Antibiotics and COVID-19: A dangerous relationship

Although there are no relevant studies that, for now, have linked higher mortality from COVID-19 to a national history of poor antibiotic prescription, those responsible for Happy Patient, with the family doctor and researcher Doctor Carles Llor at the head , coincide in
highlighting that an immune system exposed excessively and overtime to antibiotics is in
worse conditions to face a new virus for which there are no defenses, so, in the words of
Dr. Llor himself, «a greater number of complications in patients exposed to prolonged use of antibiotics are foreseeable, especially in the context of nursing homes, where the use of
antibiotics are close to being arbitrary”.

The scientist Carles Llor warns that “in the face of the global COVID-19 pandemic, people
with respiratory ailments are being treated with antibiotics all over the world, without this
having any effect on their health improvement neither on the elimination of the virus», and considers that «if at this time we can speak of a decrease in the prescription of antibiotics on a European level, it is not thanks to a change in pharmacological practice, but to a collateral consequence of lockdowns, which have prevented close contact with patients.”

Dr. Llor also agrees that «the COVID-19 pandemic may be a unique opportunity to make a clean slate in the customs and antibiotic automatisms that too many health professionals turn to when having to navigate the seas of diagnostic uncertainty.” 

During the next 3 years, Happy Patient and the countries that are part of this European consortium will try to change the nowadays threatening paradigm. The start of the project
is the 1st of January 2021 and the Kick-off meeting is scheduled for January 14-15, 2021.

The Project

HAPPY PATIENT will implement a patient-centred approach, engaging health care professionals, which act as first points of contact to the health care system and are responsible for the management of community-acquired infections. 

The health care professionals to be involved in the HAPPY PATIENT project are: 


• Providers of primary health care services such as General Practitioners (GPs), nurses and dentists  

• Clinicians in Out-of-Hour (OOH) Services  

• Clinicians in Nursing Homes  

• Pharmacists. 


HAPPY PATIENT will implement a multifaceted intervention based on state-of the-art procedures and information to change practice behaviour and patients’ perceptions about antibiotic use and AMR.

Based on the Audit Project Odense (APO) methodology 1 , a context analysis will be performed, enabling the identification of quality problems, which will be addressed in the different components of the multifaceted intervention.

The project’s work will make available practices and materials focused on the most important interaction in terms of understanding and implementing more responsible antimicrobial prescription and usage for human consumption: the interaction between health care professionals and patients. As a result, an ongoing impact will be delivered through the immediate ability to localise and up-scale outputs to national, regional, and local levels.

Happy Patient’s partners

Health Catalan Institute (ICS); IDIAPJGol Research Institute, University of Copenhagen (UCPH), University of Southern Denmark (SDU) and its Research Unit for General Practice Odense (RUPO), Norwegian Research Centre (NORCE), The Capital Region of Denmark, Rijksuniversiteit Groningen (RUG), University of Las Palmas de Gran Canaria (ULPGC) & Fundación Canaria Parque Científico Tecnológico (FCPCT), Nice University Hospital (CHU de Nice), My Family Doctor (Mano Seimos Gydytojas), Medical University of Lodz (MUL), University of Crete (UoC), Spanish Society of General  Practitioners (SEMFYC), European Association for Clinical Pharmacology (EACPT), Centre Hospitalier Universitaire de Rennes (CHU Rennes) and the International University of Catalonia – Patients Institute (UIC)