Addressing Antimicrobial Resistance in Malta: Overcoming Obstacles in Stewardship

Malta records one of the highest community antibiotic consumption rates in the EU; a new systematic review identifies behavioral, organizational, and policy drivers that sustain this level of use—underscoring immediate implications for outpatient prescribing and community pharmacy workflows where most antibiotic exposure occurs.

Malta’s per-capita community antibiotic use and its broad-to-narrow spectrum ratio remain markedly elevated compared with EU averages, increasing selection pressure for antimicrobial resistance (AMR). Earlier national measures have not closed implementation gaps, so overuse persists in ambulatory care and continues to drive AMR risk at the practice level.

Diagnostic uncertainty drives precautionary prescribing: point-of-care testing and rapid diagnostics are limited, consultations are time-pressured by patient expectations, and professional indemnity concerns favor defensive choices. The net effect is reduced guideline concordance in routine primary care.

Practical collaboration between general practitioners and community pharmacists is a key facilitator—through medication review, point-of-dispensing checks, and shared antimicrobial stewardship messaging that reinforces appropriate therapy. Yet formal communication channels are weak, commercial pressures in some pharmacy settings persist, and inconsistent e-prescribing and interoperability limit coordinated action. Strengthening interprofessional links is an actionable leverage point to improve prescribing and dispensing practices.

At the policy and organizational level, enforcement is uneven, One Health-aligned measures remain fragmented, and stewardship functions (surveillance, rapid diagnostics, dedicated staff) are under-resourced. Effective interventions must combine regulatory enforcement, sustainable financing, and system interoperability to create enabling environments; system-level reform is required to sustain practice change across primary care and pharmacy sectors.

Key Takeaways:

• Targeted diagnostic support and accessible rapid testing can reduce precautionary prescribing and shift selection toward narrow-spectrum agents.
• Primary care clinicians and community pharmacists bear the greatest impact; private-sector commercial dynamics can amplify inappropriate use.
• Align enforcement, financing, interoperable IT, and diagnostics to enable sustained stewardship—targeted, evidence-aligned interventions are warranted.