Antibiotics have been considered as miracle drugs. Since the discovery of penicillin in 1928, antibiotics have saved millions of lives, prevented deaths from various common diseases like pneumonia and meningitis and have been the force behind success of complicated surgeries and transplants. However, the resistance to antibiotics among bacteria has closely followed its use. The global community has been facing a twin challenge in the last decade with stagnation in the discovery of new antibiotics and the resistance to antibiotics growing at an alarming rate. Simply put, no new antibiotics are being discovered to treat these drug-resistant bugs.
All countries, the WHO, UN and even the World Economic Forum have been looking at causes of the emerging resistance and also ways to prevent or delay the apocalypse of common infections becoming untreatable. Of various causes, which include high volume use of antibiotics in poultry and farming to environmental contamination from pharmaceutical factories, the misuse of antibiotics by doctors has been highlighted. The only strategy adopted by various organizations, including the Government, has been to study and share data on the resistance profile and develop an “antibiotic policy”. There has not been a reasonable investment of resources into reviewing why doctors do not adhere to good prescribing factors, and there has not been any strategy to address this important aspect of implementing the “policy”.
Examples are antibiotics in a dengue fever patient, amikacin for typhoid and clindamycin 300mg twice daily. The fact is dengue is a viral infection and both amikacin and clindamycin are meant to treat bacterial infections. The fear of delayed response or adverse patient perception from failure of his clinical judgment forces antibiotic prescriptions. Educating the public that antibiotics are not required for specified conditions like food poisoning, after a clean surgery, and most of the sore throats/cough can go a long way in addressing this.
The patient should ask the prescriber – why do I need this antibiotic? Public should be educated on adverse effects like toxicity from antibiotics along with the broad public health issue of rising drug resistance. The use of print and digital media can be used very effectively for this. People dying from untreatable infections are a reality today, faced by many doctors managing the critically ill. If mankind has to survive this onslaught of drug-resistant organisms, strong actions have to be taken both at the individual level (patients and doctors) and at the governance level (state/national).
Reasons for antibiotic misuse
1 Lack of training and good mentors: This can only be rectified with strengthening the basic medical education curriculum, where strong impetus is placed on antimicrobial use and basic infection control aspects. This can be one of the most effective strategies that the Government and medical universities can consider. Only if medical students are trained under mentors who believe and practice good prescription practices, this aspect will be ingrained in their individual practice. Involving the senior faculty of teaching medical institutes and knowledge sharing by these doyens of medical practice to the rest will be another effective strategy.
2 Lack of good diagnostic skills and resources: Many infectious syndromes have to be diagnosed on basis of clinical assessment (sore throat/pharyngitis) and a decision has to be taken whether to prescribe antibiotics or not. The lack of microbiological diagnostics of required standards and capabilities, even in reputed training centers, severely limits the learning ability and clinical experience of doctors.
3 There has to be focused training in clinical diagnosis of common infectious syndromes which utilize the bulk of antimicrobials with extensive investments in microbiological labs, including molecular diagnosis, to address this issue.
4 Patient demand for unrealistic results: Often patients demand quick fix solutions overriding the good clinical sense of the physician and push him into prescribing antibiotics – typically azithromycin for sore throat. Most "sore throat" or pharyngitis is caused by various viruses. Rarely bacterial in adults, then also it's penicillin which is the first drug of choice.
(The author is chief of infectious diseases at Aster Medcity)
