Antibiotic Resistance: Global threat to healthcare system
What are antibiotics and antimicrobials?
Antibiotics and antimicrobials are drugs used to treat infections caused by bacteria, viruses, fungi, and parasites. However, there are some key differences between the two medications:
Antibiotics:
They specifically target bacteria and are used to treat bacterial infections. They do not work against viruses, parasites, or fungi.
Examples include penicillin, tetracycline, and ciprofloxacin.
Antimicrobials:
A broader term that includes antibiotics and other drugs used to treat infections which include drugs that fight viruses, fungi, and parasites in addition to bacteria
What is antibiotic misuse?
Inappropriate use of antibiotics leads to antibiotic-resistant bacteria and reduces the effectiveness of antibiotics.
Examples of antibiotic misuse include:
Taking leftover antibiotics from a previous illness
Requesting antibiotics from a healthcare provider for a viral illness
Using antibiotics as a preventive measure
What is antibiotic resistance?
The ability of bacteria to counteract the effects of antibiotics & makes the treatment challenging or impossible.
Antibiotic resistance can be due to multiple reasons; a few include
Overuse and misuse of antibiotics
Poor infection control practices
Lack of development of new antibiotics
Spread of resistant bacteria between people and through the environment.
Why is antibiotic resistance a problem?
Antibiotic resistance is a threat to public health. It can lead to
Prolonged illness and suffering
Spread of treatment-resistant infections
Increased risk of death, especially in vulnerable populations such as the elderly and people with weakened immune systems
Increased healthcare costs due to the need for more intensive or prolonged treatment
Antibiotic resistance also threatens many medical advances such as organ transplantation, cancer chemotherapy, and surgery that rely on antibiotics to prevent and treat infections.
What is the current prevalence of antibiotic resistance in India?
Antibiotic resistance is a global health problem affecting all countries and regions. According to the World Health Organization (WHO), antibiotic resistance is on the rise, making it difficult to treat common infections and threatening the effectiveness of modern medicine.
India faces a high burden of infectious diseases, leading to high antibiotic use. Excessive and inappropriate use of antibiotics combined with inadequate infection control lead to the development and spread of antibiotic-resistant bacteria. According to a study by the Indian Council of Medical Research, about 60% of bacterial infections in India are resistant to first-line antibiotics, and the trend is increasing.
The most problematic forms of antibiotic-resistant bacteria include:
Methicillin-resistant Staphylococcus aureus (MRSA)
Multidrug-resistant Acinetobacter
Carbapenem-resistant Enterobacteriaceae (CRE)
Extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae
What are the causes of antibiotic resistance in India?
Antibiotic resistance can be due to various factors:
Improper usage of antibiotics by physicians: It can occur for a variety of reasons, including patient pressure, a lack of access to diagnostic tools, or being unaware of their proper application.
Access to healthcare is limited in developing countries, leading patients to self-medicate with antibiotics or seek treatment from non-medical providers.
Improper regulations and enforcement measures for the appropriate use of antibiotics can lead to overuse and misuse.
Inadequate education and awareness about the use of antibiotics and the dangers of antibiotic resistance.
Availability of the drug in hospitals (government/institutional supply)
The widespread use of antibiotics in agriculture, especially in animal feed, contributes to antibiotic resistance.
Other causes of antibiotic resistance that require attention include:
Clinical pharmacists and antibiotic misuse: Improper dispensing of antibiotics without a prescription and giving the wrong advice about dose and duration can lead to antibiotic resistance.
Alternative practitioners and antibiotic misuse: Prescribing antibiotics inappropriately or without proper diagnosis.
Antibiotics and Critical Care: Antibiotics play a critical role in the treatment of infections in critical care settings, such as the intensive care unit (ICU). The misuse of antibiotics in critical care is a growing concern due to the potential for antibiotic-resistant infections to develop. The overuse or misuse of antibiotics in the ICU may be due to factors such as pressure to treat infections quickly, lack of rapid diagnostic tests, and lack of knowledge about appropriate antibiotic use
Antibiotic misuse by laypersons: This refers to taking antibiotics without a proper diagnosis or prescription from a healthcare provider. This can include self-medicating with leftover antibiotics, taking antibiotics prescribed to someone else, or taking antibiotics for viral infections that are not effective against viruses. This can contribute to the problem of antibiotic resistance.
How to combat increasing antibiotic resistance:
Antibiotic resistance is a complex problem that requires a coordinated response from multiple sectors, including healthcare providers, patients, public health agencies, agriculture, and the environment. To address this, it is necessary to implement programs for the responsible use of antibiotics, increase education and awareness about the appropriate use of antibiotics, enforce regulations and guidelines for the use of antibiotics, improve infection control practices, stop the over-the-counter sale of antibiotics, and enforce the law against the prescription of antibiotics by non-physicians, etc. In addition, it is important to promote the development of new antibiotics and improve infection control in healthcare.
What is antibiotic stewardship?
Antibiotic stewardship is a coordinated program that promotes the appropriate use of antibiotics to improve patient outcomes, reduce antibiotic resistance, and limit the spread of infections. This includes strategies such as
Selecting the right antibiotic for the right patient,
Determining the appropriate duration of therapy,
Preventing infections through infection control measures,
Monitoring and tracking antibiotic use and resistance patterns.
The problem of antibiotic resistance requires a multidisciplinary and coordinated global response to reduce its impact and preserve the effectiveness of antibiotics.
Summary: Antibiotics are drugs used for the treatment of bacterial infections and have no action on viruses, fungi, or parasites. The inappropriate use of antibiotics is one of the main reasons for antibiotic resistance. Antibiotic resistance and the lack of newer antibiotics is a major global concern; it affects mankind in multiple ways prolonging hospital stays, increasing mortality, and halting newer developments like organ transplantations, immunotherapeutics, etc. A multidisciplinary approach and strict regulations are required to prevent the non-judicious use of antibiotics. Also, we need to promote our research & development for making newer diagnostics and antimicrobials.
Dr Naman Jain
MD Gen Medicine, DrNB Clinical Immunology & Rheumatology
Consultant Rheumatologist, Ramkrishna Care Hospital Raipur
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