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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".