There is the need for Government and third-party audit to assess appropriate antibiotic use is non-existent in our country
Antibiotics have been lifesaving since early 1920s after the first invention of penicillin by Dr Alexander Fleming. The inventor at that time itself (1940s) warned humanity against misusing the ‘magic bullet’, the efficacy against microbes would vanish because of the development of resistance. We proved him right, in less than a century. Not only did we render the original molecule null, but also its successive modifications. This has resulted in a global epidemic of antimicrobial resistance. The proverbial “operation was successful, but the patient died” is soon going to be true; even minor infections such as tonsillitis/ appendicitis could prove fatal because we have exhausted all the effective options.
~ Dr Murali Chakravarthy, Chairman - Central Infection Prevention and Control Committee, Fortis Healthcare.
The reasons for the occurrence of antimicrobial resistance are many folds. Most important of them all is the ability of the microbial organisms to adopt to the changing environment. The bacteria modify their own cell walls, enzymatic systems and develop mutant versions to tackle the onslaught of antibiotics. These changes in the bacteria are assisted by several actions by humans. They are, using wrong doses (usually under doses), wrong antibiotic, not completing the prescribed dosage schedule, and treating viral infections with antibiotics, which are not essential.
What are the adverse outcomes of drug resistance?
The bacteria, which get resistant will withstand treatment with even normal doses of appropriate antibiotics, thereby rendering the treatment ineffective. Even relatively minor infections get difficult to or impossible to treat. The cost and morbidity of treatment will increase. Cross-Infection may increase the community acquiring multi-drug resistant microbial infection. An infection, which was hitherto treatable becomes extremely resistant and fatal. The case of resistance of tuberculosis to conventionally used antitubercular treatment is a case in point. This scenario is complicated by the fact that there are no new antibiotics in the pipeline. The reasons are two-fold; firstly, the pharmaceutical industries are not keen on investing in research and development of newer antibiotics, because their use will again be curtailed by the infection control community. They are therefore called the “orphan molecules”. Secondly, governments have not invested in developing these molecules.
Several reckless actions that caused antimicrobial resistance to antibiotics are:
Why should antibiotics be rationally used?
Judicious and rational use of antibiotics is perhaps the only tool available to us today. The humongous problem of antimicrobial resistance was caused by irrational reckless use of antibiotics. We have reached a point, where no newer antibiotics are available. By judicious and rational use of antibiotics, we may be able to undo some of the problems of worsening antimicrobial resistance. If we don’t carry out antimicrobial stewardship, we may be left with a few last antibiotics to treat infections. Hospital spaces have a role to play.
With these measures, there is a gradual decline of the use of precious higher antibiotic at Fortis hospitals. By generating peer pressure among doctors, a sense of competitive spirit is generated, that promotes overall improvement inappropriate antibiotic use.
The issue of antimicrobial resistance to antibiotics is multifaceted and requires the will and tenacity of many stakeholders from the governments of countries to the general public. The physicians play a major pivotal role in aligning these members to achieve success. Many countries have already escalated the epidemic of antimicrobial resistance to a high priority requiring the attention of the highest government officials. Even India has in principle produced a ‘white paper’ – a well-researched document with good scientific evidence. However, its execution in letter and spirit is yet to occur. While these governmental procedures are underway, responsible doctors may ‘suo moto’ participate in self-regulated antimicrobial stewardship and contribute to the good cause.
With 56 hospitals across the nation and over 10,000 beds, Fortis Healthcare Limited is a leading integrated healthcare delivery service provider in India. For over 26 years, Fortis Hospitals have been committed to the cause of getting people back to their lives faster and stronger.