Hospitals need to prepare and implement an antibiotics policy, and keep a close watch on the use of these drugs, feel experts.
The medical fraternity in Mumbai has expressed its utmost concern following the United State’s Centre for Disease Control (CDC) and Prevention’s recent statement that antibiotic-resistant germs have the highest impact on human health.
Dr Pravin Amin, an intensivist in Bombay Hospital, said, “The antibiotic-resistance problem is worse here in comparison to the West. In the past few years, we have seen a rapid rise in antibiotic resistance. Earlier, the bacteria that showed 90% sensitivity to antibiotics are now showing just 20-30% sensitivity.”
Antibiotic resistance is a condition in which bacteria resists a drug to which they were originally sensitive. “No new group of antibiotics have been developed since the 1990s,” said Dr Khusrav Bajan, consultant intensivist at PD Hinduja Hospital, adding that “the microorganisms have evolved at a higher speed than drug development. The current high-end antibiotics have become ineffective in some infections. Carbapenem is the last group of antibiotics developed worldwide.”
According to experts, anti-microbial resistance is the inevitable result of inappropriate use of antibiotics in hospitals and in the community (including sub-therapeutic doses due to ignorance about resistance mechanisms), widespread over-the-counter sales of antibiotics and patients failing to complete their courses of antibiotics.
“If you have a particular target pathogen, you should use specific antibiotics. To avoid resistance, there’s a need to improve infection control practices in hospitals. The hospitals will have to prepare and implement an antibiotics policy and have to set up a committee to keep a close watch on the use of antibiotics,” said Dr Ameeta Joshi, head of microbiology department, JJ Hospital.
To combat this health threat, CDC identifies four core actions critical to stop resistance
1. Preventing infections, preventing the spread of resistance
Avoiding infections reduces the amount of antibiotics that have to be used and reduces the likelihood that resistance will develop. Drug-resistant infections can be prevented by immunization, infection prevention actions in health care settings, safe food preparation and handling, and general hand washing.
2. Tracking
CDC gathers data on antibiotic-resistant infections, causes of infections, and whether there are particular reasons (risk factors) that cause some people to get a resistant infection. With that information, experts can develop strategies to prevent those infections and prevent the resistant bacteria from spreading.
3. Improving antibiotic use/stewardship
Perhaps the most important action needed to slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary. The commitment to always use antibiotics safely and to choose the right antibiotics and to administer them in the right way in every case is known as antibiotic stewardship.
4. Developing drugs and diagnostic tests
Because antibiotic resistance occurs as part of a natural process in which bacteria evolve, it
can be slowed but not completely stopped.
new antibiotics will always be needed to keep up with resistant bacteria, as will new tests to track the development of resistance.
A global concern
AMR hampers the control of infectious diseases.
AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others.
AMR threatens a return to the pre-antibiotic era. AMR increases the costs of health care.
Key facts about AMR (from WHO site)
Infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death.
Resistance to earlier generation anti-malarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
A high percentage of hospital-acquired infections are caused by highly-resistant bacteria such as methicillin-resistant Staphylococcus aureus.
Inappropriate use of antimicrobial medicines provides favourable conditions for resistant microorganisms to emerge, spread and persist.
4,40,000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 1,50,000 deaths.
Antimicrobial/ Antibiotic resistance
Antimicrobial resistance – also known as drug resistance – occurs when microorganisms such as bacteria, viruses, and parasites change their ways, which render the medications used to cure the infections, ineffective. When the microorganisms become resistant to most anti-microbials, they are often referred to as ‘superbugs’. This is a concern as a resistant infection may kill, can spread to others, and impose huge costs.
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