Korea had long been notorious for the abuse of antibiotics with the phrase antimicrobial resistance (AMR) on the lips of nearly every doctor, druggist and patient.

Now, however, local doctors are thinking more carefully about their antibiotic use with new drugs failing to keep pace with increasing AMR outbreaks.

AMR is rising as bacteria are gradually finding a way to resist the antibiotic effect. According to various reports, the number of people who die from resistant bacteria -- or superbugs -- caused by the indiscriminate use of antibiotics, which is the main problem of antibiotic resistance, has reached 700,000 worldwide annually.

Other countries have started to control the dangers of AMR. Japan, for example, has organized the “AMR Clinical Reference Center” and established an antibiotic use monitoring system with an annual budget of about 2.7 billion won ($2.4 million). The U.K. Department of Health and Social Care has also succeeded in reducing the use of national antibiotics by giving incentives to clinics that have reduced antibiotic use.

In line with the rise in global awareness of AMR, the Korean government has also set aside an additional budget of 47 billion won for the next five years to prevent the disease.

The money will help to finance the establishment of a new team, headed by the Ministry of Health and Welfare and composed of officials from the Ministries of Science and ICT, Food and Drug Safety, Agriculture, Food and Rural Affairs and Oceans and Fisheries, to identify the mechanisms by which antibiotic resistance develops and spreads, health and welfare ministry officials said.

The new task force will study the results and come up with a treatment strategy by looking into all aspects, including human, animal and environmental causes.

Local experts point out this is not enough to control the spread of AMR, however.

“AMR can affect anyone, regardless of country of residence or age, and is a threat to the treatment of serious infections and the provision of standard medical procedures,” said Professor Lee Jae-gap of the Department of Infectious Diseases at Kangnam Hallym University Medical Center.

Lee stressed that one of the significant problems facing Korea is that it is failing to decrease the number of antibiotics in contrast to many of other member nations of the Organization for Economic Cooperation and Development.

According to the Health Insurance Review and Assessment Service (HIRA), domestic antibiotic had continuously risen since 2009. Korea’s use of antibiotic reached 34.8 DDD -- defined daily dose, a statistical measure of drug consumption established by the World Health Organization -- in 2016. The number means that as of 2016, 34.8 people are prescribed antibiotics per 1000 people per day.

Last year, Korea's antibiotics use was third highest among 26 OECD countries, after Turkey (40.6 DDD) and Greece (36.3 DDD). The Korean figure in 2016 was 1.6 times higher than the OECD average of 21.2 DDD, an increase from 2008 when Korea's use of antibiotics (26.9 DDD) was 1.2 times higher than the OECD average of 21.7 DDD.

The data showed that one of the leading causes of the rise in antibiotics was common antibiotics prescriptions for cold patients by medical institutions.

“When I was studying in the U.S. doctors used to prescribe one or two medicines to cure my cold,” said Song Min-sang, a student who graduated from a U.S. college. “However, in Korea, I received up to four to five pills to cure the same cold.”

Song said he believed that the increase in medicine was to cure his cold more swiftly, but nobody had explained to him about the dangers of AMR. “I believe that most of the people around me do not know anything about AMR,” Song added.

The government has noticed such problems and set up an antimicrobial stewardship program in 2016 aimed at reducing antibiotic use by 20 percent by 2020.

Since then, the prescription rate for antibiotics for the cold has somewhat reduced, but the prescription rate for acute upper respiratory infections is still high, and the effectiveness of the drug is declining.

The stewardship program also penalizes hospitals that prescribe excessive amounts of antibiotics by increasing outpatient management through the "appropriate evaluation of antibiotics for medical institutions.”

Since the government implemented the system, however, the number of medical institutions that have received a grade 4 or 5 for excessive antibiotic prescriptions has remained at 2,200 for the fourth consecutive years raising questions about the effectiveness of the program.

Many experts say the current system remains inadequate, calling for the government to commit to reducing antibiotic use more aggressively.

At the “Antibiotic Resistance Prevention Week Forum” last month, experts on antibiotics gathered and recommended the government to establish a new antibiotics management division under the Ministry of Health and Welfare similar to that of Japan or the United Kingdom. The government has yet to decide to establish a control tower for AMR under the health and welfare ministry, however.

HIRA has also recommended in a recent report that the government needs to strengthen its current stewardship program to reduce antibiotic use further.

"The range of antibiotic stewardship programs is fairly limited, and infrastructures such as personnel and costs to implement them are inadequate," said Kim Dong-sook, the lead author of the report.

To improve these problems, HIRA should provide a method to calculate and deliver customized information for each medical institution and activate the stewardship program for managing the appropriate use of antibiotics in the hospital itself, Kim added.

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