Judicious Use of Antibiotics and Prevention of Drug Resistance

By 121 News

Chandigarh 21^st January:- Antimicrobials commonly referred to as antibiotics, have been the backbone of health care. They were responsible for decreasing the morbidity and mortality associated with infections of various kinds like pneumonia, meningitis, tuberculosis, etc.  An additional and often overlooked contribution of antibacterials was in decreasing infections after surgery.  However, at the time when penicillin was introduced, it was noted that antibiotics if used in an indiscriminate way, may lead to development of resistance amongst bacteria. This was what was warned against but was not heeded to. Now, we have an array of organisms which are resistant to not one but nearly all groups of antibacterials .The problem is that the infections caused by these organisms are not only serious but also difficult to treat. The double whammy exists because of the fact that there are very few agents being developed for tackling these infections. Resistant organisms being found from various samples from patients with suspected infections are increasingly becoming a cause of concern. In a study conducted in 15 Indian tertiary care centres  including PGI, Chandigarh during a two year period from January 2008 to December 2009, the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) was found to be very high (41%) in India. This is a major concern judged by the fact that even a single case in a western set up is handled in isolation in a hospital. 

Bacterial diseases develop resistance to treatment with antibiotics when the antibiotics are wrongly used to treat viral infections or when inappropriate antibiotics are used for bacterial infections or when a full course of drugs isn't completed or not administered in appropriate doses. Resistance also develops if animal feeds, food products and water is contaminated with antibacterials. In order to curtail this problem, which is growing by the day, it is of utmost importance that a joint responsibility is demonstrated by all the stake holders.   

Keeping in view the fact that these organisms are becoming an increasing source of problem for the treating physician and the patient alike, PGI, Chandigarh has started antimicrobial stewardship exercises in various units of the hospital under the guidance of antimicrobial stewardship committee of the Institute.  It was realised that while stewardship exercises could improve the know-how for handling such infections more effectively in the hospital settings, it is important to move out our message of judicious use of antibiotics to healthcare givers and recipients in the community. An important reason for this lies in the fact that often the patients that come to PGI have already been administered, what are called, high-end antibiotics when perhaps they were not required. This may not only foster the existing infection but may even complicate it further and allow more resistant organisms to grow.  Antibiotics are for sale without prescription in pharmacies in India and there are no national guidelines for clinicians on their use in hospitals. This is in contrast to many western and European countries where these drugs can hardly ever be purchased available without prescriptions meaning thereby that the chemist shops cannot dispense them without a valid prescription. GOI is working on this but let's see when India sees the dawn of this as being implemented. GOI has designated four centres in India to detect the prevalence of resistance and soon the data will start pouring in to give the true picture at National level. These four centres are – PGI, Chandigarh; AIIMS, Delhi; JIPMER, Puducherry and CMC, Vellore. There is thus a need for the consumers, treating physicians, administrators, regulators and scientists to come together to 1) increase the awareness about the problem and its consequences, 2) develop a guidance document for treating various infective ailments, 3) set up mechanisms for audits for checking adherence to policies at each level of health care, 4) regulators and administrators to take steps to reduce environmental contamination by antimicrobials and, 5) increasing awareness among consumers about avenues for misuse of antimicrobials.  Two important documents have laid down the framework for establishment of mechanisms for streamlining proper use of antimicrobials. These are the Chennai Declaration and the document produced by Global Antibiotic Resistance Partnership, India-Working Group. However, much needs to be done to bring about changes at the ground level.  We have several models existing in the developed world. However, we should now draft out the framework for executing our actions.