The WHO’s World Health Day 2011 which falls on April 7th , has as its theme, a very relevant and frightening issue facing today’s health care management- ‘no action today, no cure tomorrow.’ This relates to increasing worries about the growing menace of emerging and expanding Antimicrobial (or antibiotic) resistance among microbes. Statistics would have been more apt to highlight this issue. Unfortunately no national data exist. Only local, hospital specific data circulate and thus highlighting the urgent need to put in place methods to track infection and drug resistance information at a national level.
Available data suggest that resistance of bacteria to many classes of Antibiotics are appearing. This has caused the appearance of different species of ‘Super-bugs’. While we tend to divert our attention to the controversies that surround a ‘name’, our focus needs to get re-routed to developing a cohesive networking to collect and analyze data and thereby address specific National policies for the correct and relevant use of Antibiotics.
Emergence of Antimicrobial Resistance (AMR) is complex and multi-factorial. A single isolated intervention may have no significant impact. Some of the issues driving this AMR may be attributable to:
-Consumers and communities are not made aware of the harms of unnecessary use of antibiotics.
-No National Surveillance systems for tracking AMR are in place. We cannot address a problem if we do not know the magnitude of its existence.
-Regulations for the use of quality and supply of antimicrobials are not stringent enough.
-The ever increasing over-use and abuse of Antimicrobials in humans and animal husbandry.
-Inadequate and poor Infection control policies and their implementation.
-A growing inadequacy of available Antibiotics and diagnostic tools or R&D for development of the same.
Highlighting one aspect of irrational use of Antibiotics that is often ignored or not addressed adequately is in the field of ‘Surgical Antibiotic Prophylaxis’. Surgical Antibiotic Prophylaxis is used only with the specific purpose of avoiding infection at the surgical site, when infection in not present, but the risk of post-operative infection exists. This however is only an add-on to prevention of such infections and is not the only preventive method. However in the current scenario, the Antibiotic(s) is required to be a ‘magic bullet’ to overcome lapses in surgical techniques, pre and post-operative care, and basic infection control practices. What requires just one dose or 1 day of the drug is administered often for even 7 – 10 days. Those in the Private and Public sector hospitals are equally guilty of such misuse of antibiotics. The end result is that due to attempts of managing the ‘ghost’ of a possible infection, we end up being responsible for the development of an ever expanding collection of MDROs (Multi-drug-resistant-organisms). This trend must be controlled. Practices, based on accepted scientific principles and guidelines, tailored to the local patterns of drug resistant microbes must be designed and complied with.
We need to remember that all fevers are not due to infections, all infections do not require antimicrobials, antimicrobials used may not be suitable for the situation.
Dr.Thara Francis, M.D.,
Senior Consultant Microbiologist &
Coordinator Hospital Infection Control
(Image courtesy: http://www.vivisectioninformation.com/web_images/petri_dish_large.jpg)
