Cover Story : Misuse and Overuse of Antibiotics, Dr Swati Rajagopal

For nearly a century, antibiotics have helped in the killing and control of bacteria that make human beings sick. But, in recent times antibiotics are losing their efficacy against certain types of bacteria. There are various infections caused by certain varieties of bacteria that are unbeatable by the antibiotics available now! The misuse or overuse of antibiotics have led to the creation of the multi-antibiotic drug-resistant “Superbugs.”

According to the United States Centers of Disease Control [CDC], these drug-resistant bacteria infect more than 2 million people nationwide and kill at least 23,000 people each year. Drug-resistant forms of tuberculosis and Staphylococcusaureus infections are now common in India, too.

Inappropriate practice of prescribing

The reason for the spread of such drug-resistant infections is the inappropriate antibiotic prescribing practice. Antibiotics work only against bacteria and not against viruses. In certain places, antibiotics are prescribed for common cold/ flu and leads to their unnecessary use. Appropriate use of antibiotics would destroy the bacteria causing the infection. But, if an individual is prescribed an antibiotic for a viral infection like influenza, the drug would not affect the virus. Instead, the antibiotic would attack the “good bacteria” in the gut of the human body that are in fact helpful to fight infections of the gut. The bacteria that are tough enough to survive the drug will have a chance to grow and replicate. These drug-resistant strains may spread from person to person.

In the past, these drug-resistant bacteria were confined to health-care facilities as people were sick and had weaker immune systems. But, now the drugresistant organisms are also seen in the community.For Example, Methicillin Resistant Staphylococcus Aureus ( MRSA) was earlier seen in hospitals, but now it is seen more frequently in the community. This bacteria is responsible for causing skin and soft tissue infections and is resistant to methicillin and related antibiotics.

Antibiotics form a very important group competent in delivery of effective health care. But, with the rise of drug-resistant bacteria the concern is non-availability of new drugs to fight against such infections.
The difficulty in the administration of the antibiotic by the clinician is an educated guess! The rationalization of the antibiotic depends on the availability of the culture reports from the laboratory. This takes a minimum of three to five days depending on the body fluid that is being tested.

Since the research on drug development to fight these drug-resistant bacteria takes time, it is important to prevent the spread of such infections through appropriate hand hygiene, avoiding unnecessary use , misuse, underuse or overuse of antibiotics

As always, in Medicine, prevention is better than cure!!

Take-Home Messages

  • Antibiotics help in killing bacteria and not viruses. So, no antibiotics for common cold or flu!
  • If you feel sick, consult your health care provider to get a clear understanding of the symptoms and appropriate treatment. Appropriate diagnostic tests may be conducted to help in the rational prescription of the antibiotic
  • If antibiotics are indicated by the physician, ensure that right dose, right time and right duration of medicine are made clear to you.
  • Do not self-prescribe antibiotics!
  • Do not buy antibiotics over the counter from the pharmacy. The prescription should be clinician-driven!
  • We are at the end of the road with respect to antibiotics targeted towards killing drug resistant bacteria. Molecules are under research. But, we need to prevent spread of such infection by maintaining appropriate infection control measures like washing hands with soap and water, surface disinfection and sterilization and by following cough etiquette.
  • Healthy lifestyle – Including a proper diet and exercise will help prevent infections and thereby help in preventing the overuse or misuse of antimicrobials.
  • Avoid use of antibiotics in the agriculture and livestock industry

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