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Author: Ilaria Galetti, Vice President GILS ODV – Gruppo Italiano per la Lotta alla Sclerodermia.

Milan, Spring 1996. I was studying at the University, in an ancient cloister, when I noticed the first sign of the disease that would be my unfriendly and undesired partner of my life: systemic sclerosis, also known as scleroderma. Systemic sclerosis is a rare, autoimmune, and very complex condition, that can affect the skin, lungs, heart, gastrointestinal tract, joints, and overall, the whole body. One medicine has been approved for its treatment, but only for lung fibrosis and nothing else.

Clinical practice guidelines recommend immunosuppressive therapies to lower the immune system, but no selective or personalised therapies are available. This means that the whole immune system is affected, exposing the body to many infections. The disease causes digital ulcers, very painful and often infected, that need to be treated with topic or systemic antibiotics. A swab should always be performed to use the right antibiotics.

Immunosuppressive therapies are still too generic, meaning that they inhibit the whole immune system, paving the way to several infections (mainly lung infections). This can be difficult to treat and can require hospitalisation. A careful evaluation of which antibiotics or specific treatments must be used, should always be performed, targeting the right bacteria, viruses, or fungi.

The last two and a half years have taught us many things regarding prevention that should become routine in our daily life. Prevention plays an extremely important role. Hand hygiene, the use of masks when meeting people with the flu, meeting people who are not perfectly healthy, and when going to the hospital for check-up visits or infusion therapies, should be a must for the so-called fragile patients and their families. The lower the risk of infections, the lower the need to use antibiotics.

Another important issue is the adherence to the prescribed therapy. In too many cases the antibiotic therapy is halted by the patient when symptoms and signs of the illness disappear. Prescribers and pharmacists should stress the importance of adhering to the therapy in order to get a full healing and prevent a relapse. On top of this, patients often spontaneously use the pills that remain in their stock, with a sort of self-prescription to cure “potential” infections diagnosed by themselves.

In my experience at national and European level I would encourage a programme on the correct use of antimicrobics in the wider community of connective tissue diseases. A few tips to prevent the spread of antimicrobial resistance:

  • Don’t take an antibiotic for a virus: antibiotics only work against bacteria; they are not useful to cure a simple flu.
  • Don’t save an antibiotic for the next time you get sick: you cannot know what kind of bacteria you have.
  • Take antibiotics exactly as prescribed. Don’t skip doses. The efficacy is not immediate, it requires 3 or 4 days or even more.
  • Never take an antibiotic prescribed for someone else. As above: you do not know the bacteria has infected you.

These recommendations can help save lives including your life and the lives of those close to you.