Experts warn against rampant use of antibiotics

Lack of restrictions may cause widespread antibiotic resistance’

Published - October 27, 2018 12:52 am IST - KOCHI

With the rampant use of antibiotics, it is quite likely that a situation may arise similar to the pre-antibiotic era. Infectious diseases that were treatable once becoming non-treatable will leave the medical fraternity with no solution, according to experts in antimicrobial resistance (AMR).

Addressing the media ahead of the two-day International Conference on Antibiotic Stewardship and Infectious Diseases, experts said the crude infectious disease-related mortality rate in the country was 416.75 per 1,00,000 persons, twice the prevalent rate in United States. The country also has a 15-time greater burden of infectious diseases per person than in the UK.

The absence of restrictions on access to antibiotics and their irrational use, non-standardised microbiology laboratories, use of antibiotics in animal husbandry and fisheries, and lack of sanitation are leading to widespread antibiotic resistance. This happens as the bacteria changes its form to overcome the effect of the antibiotic used to contain or kill it. So, the use of high-end antibiotics in the first go renders ineffective the lower and middle-scale antibiotics against microbes in further treatment of a patient.

The conference to be held on Saturday and Sunday at Hotel Crowne Plaza will highlight the importance of antibiotic stewardship that could bring about a rational use of antibiotics with the right dose and drug, duration, and frequency, so that the burden of infectious diseases comes down.

Dr. Sanjeev Singh, medical superintendent, Amrita Institute of Medical Sciences, which is hosting the meet, said while a study had pointed out that 89% of doctors prescribed antibiotics on a daily basis, there were also around 26% patients who asked the doctor to prescribe antibiotics.

Antibiotics are prescribed for patients for upper-respiratory infections, diarrhoea, or vomiting, which are indicative of viral infections. The challenge is that there is a lack of data regarding infection control practices in hospitals. There is a total lack of standardisation around these aspects in hospitals across the country, Dr. Singh added.

Dr. Arjun Srinivasan, associate director, Healthcare Associated Infection Prevention Programs, Centers for Disease Control and Prevention, US Department of Health, said: “We can preserve the power of life-saving antibiotics by improving the manner in which we use them. It will require partnership between public and private sectors as well as engagement with patients.”

Instead of orienting just physicians, patients, hospital managements, clinical pharmacists, community pharmacists, the general public, the government has a role to play in proper use of antibiotics, said Alison Holmes, director, NIHR Health Protection Research Unit at Imperial College, London, and Public Health, England. Dr. Holmes is also leading a collaboration in antibiotic use in surgery in England, Kerala, and South Africa on how to have better outcome. She indicated that the theme of the conference ‘No Action Today, No Cure Tomorrow’ should be rephrased as ‘...No cure today and for tomorrow’.

A modern laboratory should be available to support the programme, said Dr. Singh, who said that over the last four years, Amrita Hospital had brought down the use of high-end antibiotics like Colistin by 74%, Linezolid by 86%, and Dorpenum and Ertapenum by 34% and 38% respectively. Mortality has come down by 24%, and there is a cost benefit of ₹2.3 crore a year for patients.

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