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Friday, September 18, 2015

Superbugs: Born to kill

Antibiotic resistance: The ability of bacteria and other microorganisms to resist the effects of an antibiotic to which they were once sensitive. It is also known as 'drug resistance'. 
This makes the medications less effective and as a result of which higher doses of drugs are needed which would result in more side effects. Organisms which are resistant to multiple drugs are called 'Multi drug resistant -MDR' or "Superbugs".  

Antibiotic resistance is a serious and growing global problem: a WHO report released April 2014 stated, "this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country."

India is the world's antibiotic popping capital, recording the highest number of such pills consumed annually- 13 billion, as against 10 billion in China and 7 billion in the U.S.  

What are the Indian causes for such an emergence of resistance ? 

1. Self medicating oneself by indiscriminately prescribing some irrational antibiotic. 
This is generally done by patients to save themselves the trouble of visiting a doctor. Very rarely does one succeed in treating in this manner. 
The worse situation arises when the patient self medicates and stops the antibiotic without completing the entire therapy. Perfect recipe for developing drug resistance. 

2. The other group of patients would rely on their local B Pharm chemist to dispense them some antibiotic rather than visiting a doctor. It is termed as OTC- Over the counter. This is one of the reasons why the FDA has come down hard on these retail chemist outlets. 

3. Doctors are equally to blame for this rising incidence of resistance. When the patient visits his or her General Practitioner or Family Physician with say a Viral Fever, he is prescribed an antibiotic for a few days knowing full well that an antibiotic has no role in a Viral illness.  If the fever doesn't subside, an anti malarial is added to the treatment without subjecting the patient to a battery of tests to confirm the diagnosis. Doctors are sometimes also guilty of starting Anti tuberculous treatment without sufficient evidence of the disease. 

4. Once the patient is hospitalized, the Consultant takes over the case. He generally starts with a higher and broad spectrum antibiotic since he doesn't want to take any chances. This attitude over a period of time aggravates the resistance problem and thus we see the emergence of the Superbugs. 

There is an urgent need to formulate guidelines. It is a common practice in the West to start with basic antibiotics like Co-Trimaxozole while in India we would prefer to start straightaway with a 3rd or 4th generation Cephalosporin. 

  • Antibiotics should only be used when needed and only when prescribed. 
  • Health care providers should try to minimize spread of resistant infections by using proper sanitations techniques including handwashing or disinfecting between each patient. 

  • Prescribing the correct antibiotic is important and doses should not be skipped. 
  • The shortest duration needed should be used. 
  • Narrow-spectrum antibiotics should be used rather than broad-spectrum antibiotics when possible. 
  • Cultures should be taken before treatment when indicated and treatment potentially changed based on the susceptibility report.

"It is not the human body that is resistant, it's the organism which gets resistant". 

Friday, January 30, 2015

Flu: Can we fight it?

Influenza, commonly known as flu, is a viral illness characterized by fever, runny nose, cough and muscle pains. Most often it is a self limiting ailment lasting for less than a week.

Only 16% of patients with Influenza were prescribed Antivirals whereas as many as 30% were prescribed antibiotics. Unfortunately, we know that if you go to a Physician for a flu, you are more likely to leave with a prescription for antibiotics that you don't need than for an antiviral that might do you some good. 

If antivirals are started within 48 hrs of onset of symptoms, there will be an improvement of 30 hrs in time to getting better but if they are started after 48 hrs, there is not much benefit.

The problem might be a consequence of a lack of familiarity with antivirals and confusion over when to use and when not to use them. Also, there is a "deeply ingrained tendency" to prescribe antibiotics for sick patients because they need something or because of the perception that patients are going to be happier.
Inappropriate usage of antibiotics has thus led to a major crisis in antibacterial resistance.

Another very important reason is that clinicians 'don't want to risk missing anything'. Even if they know that out of 99 influenza cases, fewer than one will have a bacterial superinfection, physicians don't want to have not treated that one person who develops bacterial pneumonia as a complication of flu. It is true that flu predisposes to bacterial pneumonia, but it is not true that giving an antibiotic will prevent it, because the patient is likely to be infected with a different bacterium from the one targeted by the antibiotic. And if you treat 100 patients who don't need an antibiotic, you are probably going to send one to the hospital with a rash. If several develop diarrhea you will do far more harm than good.


Prevention is better than cure they say. A shot of the Influenza vaccine at the beginning of the cold season is recommended for everybody above the age of 6 months especially those at high risk - Immunocompromised, asthmatics, diabetics, etc. But the prevention rate is a measly 23%. The virus has a very high tendency to mutate and change its form. As a result, the antibody produced against the virus fails to destroy it. Also, the improper maintenance of the cold chain for preserving the vaccine has led to the high failure rate. Despite all this, the vaccine should be administered as advised since the benefits however small they seem, far outweigh the zero risk. The vaccine protects against certain strains of influenza, including the B viruses, which can cause severe disease and complications in infants, young children, and the elderly.

"Someone told me that they didn't want to take a flu shot because they didn't want to put a foreign substance in their body. What do they think they do at dinner every night?"

The flu is very unpredictable when it begins and in how it takes off.

Excerpts from Medscape