Antibiotic Use, Misuse – Raise of SUPER-BUGS?

Dr.T.V.Rao MD Antibiotic misuse is a great concern, Microbiologists working with true spirit are the first people to observe the growing drug resistance patterns, today we have many K. pneumonia arising from chronically ill patients and many are presenting as hospital acquired infection, Increasing number of strains are resistant to 3rd generation cephalosporins and we are testing for sensitivity patterns to carbapenem group of antibiotics resistance with Imipenam and Meropenam is a Universal concern , The fact is that we are soon approaching a stage where you as an individual will know someone who died of a drug resistant infection. Ten years ago we didn't really have many issues with carbapenem resistance in gram negatives and now we have a class of bacteria called entro-bacteria popularized with NDM strains and we have very common carbapenem resistance. A sample survey conducted by the World Health Organization in New Delhi in April 2011 revealed that more than half (53%) of Delhi-ites surveyed self-prescribe antibiotics. One in four of those surveyed stop taking them once they felt better, instead of finishing the entire course. Another one in four Delhi-ites (25%) treat regular fever with antibiotics, and 18% of those surveyed re-use antibiotics in the family. According to the study, 16% to 18% physicians said they prescribe antibiotics for non-specific fever, cough, and even diarrhoea. We discuss many matters in the Institutional practices at our Medical colleges, the above said survey shows most of the patients are experimented with newer generation of drugs before he comes to the Institutional care, it will lead to a situation that the people are coming to our Institutions loaded with drug resistance bacteria, I do not know where our teachings will stand in Antibiotic policy as we cannot be rational and many patients are being treated with irrational therapies before they reach the hospital. Practically clinical Medicine is dying in India rapidly even for trivial conditions ultrasounds and elaborate investigations are done forgetting that their clinical will be supported by diagnostic protocols. In Recent interaction with Doctors at our hospital everyone has his own vision on the use of Antibiotics, and blame there are no effective Microbiology Diagnostic guidance and fully agree, in the Government and private Medical colleges, have least investments are done on Microbiology Departments, as it is not Income generating department, I feel it is time to realize that the matters are out of control, in future many patients with trivial infections will perish with drug resistant strains, We have few options other than, implanting and educating the Doctors on the National policy, or rationalist antibiotic use, as the national policy could regulate the over the counter sale, enforce, and regularly keep a tab on strong infection control measures at the hospitals across the country. More importantly, it make pharmacists, doctors, medical professionals, and healthcare institutions alike accountable for it. It will save lives across all age groups and demographics and from many diseases. Until then, it just remains India’s uncomfortable and real truth. Never forget we are all responsible for the trends in change as we thought the magic bullet is the solution, and bullet may kill the microbe and men too.

Major peer reviewed studies prove that misuse of Antibiotics are attributed to

1 Nexus between pharmaceutical industry and busy practitioners with freebies, foreign travels for specialists and sub - specialists called as SUPER SPECIALISTS

2 Doctors running their own laboratories and Chemist shops and putting the patients to unnecessary investigations

3 Lack of basic knowledge on antibiotics, many times guided by Medical reps

4 Treating the patients with minimal or no clinical l Diagnosis with no idea on what they are treating?

5 Above all patient’s ignorance to accept whatever the doctors are doing

6 Many of the senior microbiologists and Professors leaving the matters to Technician’s and junior faculty lead to all vagaries in the Laboratory science.

If the matters are not understood and effective regulations are not brought in patients in ICU and critical care areas will be at highest life threat and even many critical are areas to be closed with raise of SUPER-BUGS?

Dr.T.V.Rao MD Professor of Microbiology Travancore Medical College Kollam