Antibiotic resistance is emerging as a major problem in medical practice. The organisms (bacteria) are getting increasingly difficult to eradicate. In many situations we are left with only one effective antibiotic to be used in the ICU as all other antibiotics are rendered useless as the bacteria grow resistant to these.

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Good and cheap antibiotics like ciprofoxcillin, septran, ampicillin, amoxicillin, roxythromycin and chloramphenicol are now useless in most cases as the bacteria have developed resistance to these. In fact, many higher antibiotics like cefuroxime, ceftriaxone, pipracillin and cefoperazone are becoming ineffective in most cases.

If nothing is done to control this trend, a time will soon come when we will be left with no effective antibiotic. The other major problem is that the higher antibiotics are very costly and most patients cannot afford them. There is no regulation over the use of antibiotics. Primary care physicians are using higher antibiotics for viral and malarial fevers, throat infections and diarrhoea. Such ailments do not require any antibiotics.

In our country, the antibiotic usage including in medical colleges is largely unregulated. In developed countries, any higher antibiotic prescribed by any specialist in a hospital goes through the infectious disease team. The team’s nod is a must to dispense this antibiotic to the patient. Only the first dose can be given without permission at night as an emergency. In such countries, antibiotic resistance is still rare. The antibiotics like ciprofloxcillin, septran, ampicillin, amoxicillin, roxythromycin, chloramphenicol, ceftriaxone, pipracillin, cefoperazone are still useful in these countries and enough to treat most infections.

In India, laboratories are not geared up to report such resistances. Most don’t even have the expertise. Only a handful of laboratories in Mumbai can do a good culture test. In other cities, the situation is worse.

There is a general trend amongst many surgeons to use higher antibiotics to prevent infections during and after surgery for longer than actually needed. This may also be due to the fear of infections affecting the results of surgery.

Education programmes for doctors to improve their skills of using antibiotics rationally and introducing regulations over the use of antibiotics is also essential. Finally, the experts in the field should help laboratories to upgrade their ability of giving accurate results.

Dr Shrirang Bichu, honorary nephrologist, Bombay Hospital