Dr.GLADYS JACOB,M.B.B.S.,D.G.O.,

Consultant Gynecologist & Family Physician

&

Dr.SWARNA JACOB,M.D.,

Assistant Professor , Dept of Microbiology .,

MOBILE - 98413 82223 .,

"Misuse of Antibiotics: ".

     Today about 85% of antibiotics have a non- human use and upto 75% have a non-therapeutic use. Community use of antibiotics is inappropriate.

ANTIBIOTIC STEWARDSHIP

Definition: Nathwani et al 2012

  • Is an interprofessional effort, across continuum of care.
  • Involves timely and optimal selection, dose and duration of an antibiotic.
  • For the best clinical outcome for the treatment or prevention of infection.
  • With minimal toxicity to the patient.
  • Minimal impact on resistance and other ecological adverse events such as C.difficile.

Why Antibiotic Resistance occurs?

  • Issues of sanitation and hygiene.
  • Patient does not complete the full course of the antibiotic therapy given by the Doctor.
  • No new antibiotics have been discovered.
  • Sub- optimal dose.
  • Overuse of antibiotics like cephalosporins and Quinolones.
  • Doctors think “Just in case”, VIP Patient”, “It won’t do any harm”.

To quote FRIEDRICH NIETZSCHE

“THAT WHICH DOES NOT KILL US, MAKE’S US STRONGER”

Fallacies in Antibiotic usage commonly followed by us:

  • Broad spectrum drugs are always better.
  • Sickness requires immediate treatment.
  • When in doubt, prescribe more drugs.
  • Bigger diseases, bigger drugs.
  • Antibiotics are harmless.
  • Lab results are unreliable.

Results of such fallacies??!!

  • Super bugs(microbes with Antibiotic resistance) develop.
  • Higher instances of nosocomial infections ( Hospital aquired infections )
  • Cost of treatment is increased.
  • Increased period of hospitalization.
  • Loss of reputation of the Doctor.

We, as Doctors have two Goals

  1. To avoid emergence of Multi drug resistant organisms
  2. Develop newer Antibiotics.

What is Doctor’s Role?

  1. Prescribe antibiotics, not to all patients, but to the ones who really need them.
  2. Make a diagnosis (of infection), identify the causative organism and give drugs to that organism alone.
  3. Do not always go for empirical or broad spectrum drugs.
  4. Ensure that the patient takes the full course of the drugs that we prescribe.
  5. In case of flu or common cold or diarrhea, do not prescribe antibiotics as 90% of them are likely to be caused by viruses.
  6. Limit the surgical prophylaxis as early as possible before surgery.
  7. Avoid nosocomial or hospital ICU acquired infections as they are always multi drug resistant.
  8. Now-a-days antibiotics have become over the counter drugs. So we must advise the patients not to take antibiotics unnecessarily without the consent of the Doctor.
  9. Try and develop newer antibiotics, if possible.

What is your role as a patient?

  • Always consult a doctor before taking antibiotics.
  • Do not purchase antibiotics without a prescription
  • Judicious use of antibiotics will prevent the rise of antibiotic resistant organisms.
  • So beware - There are not many antibiotics in the future to save us.

This article is simply written based on practical problems and challenges faced as a Microbiologist. No issues are meant to hurt the feelings on any anybody in particular. No conflict of Interest.

Dr. Swarna Jacob Associate Professor of Microbiology & Dr. Gladys Jacob, Arun Clinic, Villwakkam, Chennai.

Thanjavur Medical College, Thanjavur