Abuse of Antibiotics a Major Health Threat

Abuse of Antibiotics a Major Health Threat
Posted 27 Nov 2020 | Source: Patients Engage portal

In the recent years, Antimicrobial resistance (AMR) has emerged as a critical public health issue wherein microbes have developed resistance to life-saving antibiotics. According to the World Health Organization (WHO), 700,000 people die from AMR each year. The misuse, abuse and overuse of antibiotics is one of the major causes of antibiotic drug resistance. This has led to increased morbidity, hospital costs and mortality amongst our patients.

Antibiotic capital

Another study conducted by Indian Council of Medical Research (ICMR), found that antibiotic-resistant organisms were present in the digestive tracts of two out of every three healthy persons that it tested which indicates that antibiotic resistance is fast-spreading among the Indian population and is now emerging as the antibiotic capital of the world.

As the burden of diseases is increasing in the country, it has led to an unregulated sale, overuse, and misuse of antibiotics. Several trends such as self-prescription and over the counter sales which have been contributing to high antibiotics resistance in the country.

World Antibiotic Awareness Week

It is in this context to these growing trends, that spreading awareness about Antibiotic resistance among the general populace during the World Antibiotic Awareness Week has become utmost important to us. Every year between November 18 and 24, World Antibiotic Awareness Week is observed. The vision behind observing this week is to fight antibiotic resistance, which is a risk to health and human development worldwide and which is compromising our strength to fight infectious diseases. Therefore, as bacteria in human bodies are becoming resistant to powerful antibiotics, we now need to understand the importance of antibiotics and learn to use them judiciously.

Data reveals that Multi-resistant enterobacteriaceae due to the production of extended spectrum β-lactamases (ESBL) have become very common in India. In addition, various studies in South India has highlighted the drug resistance pattern like multidrug-resistant extended-spectrum β-Lactamase producing Klebsiella pneumoniae, Ciprofloxacin resistant Salmonella enteric serovar Typhi, emergence of vancomycin-intermediate staphylococci, fluoroquinolone resistance among Salmonella enteric serovar Paratyphi A, Pseudomonas aeruginosa and Acinetobacter baumannii resistant to ceftazidime, cefepime and ciprofloxacin.

Metallo- β- lactamases (MBL) are the enzymes that mediate resistance to carbapenems. MBL producing P. aeruginosa are emerging as important causes of nosocomial infection. Prevalence of MBL producing organisms ranges from 7-65% in India.

Antibiotics can be used to treat bacterial infections and antibiotic resistance that happens when the bacteria transforms in response to the use of these medicines. The infections caused by resistant bacteria are difficult to treat when compared to infections caused by bacteria which are non-resistant. The misuse of antibiotics accelerates antibiotic resistance and leads to lack of control over infection prevention. Measures have to be taken to curtail the spread of antibiotic resistance.

What can individuals do to control the spread of antibiotic resistance?

Individuals should ensure that only certified health professional prescribes antibiotics. In case your health care provider says antibiotics are not needed, heed that advice and never consume antibiotics that are leftover and don’t share them with others.

It is important to prevent infections by cleaning your hands often, preparing food in hygienic conditions, avoiding unnecessary contact with people who are ill, ensuring safe sex, and updated vaccinations.

It is vital to follow WHO guidelines on safe food preparation like keeping food clean, separating raw food from cooked food, exposing food only at prescribed temperatures, and by using safe raw materials and water. It is also important to ensure that foods are not produced using antibiotics.

How can policy makers prevent and control the spread of antibiotic resistance?

A national antibiotic policy is in place to curb antimicrobial resistance. It is important for stake holders to adhere to the policy. The infection prevention and control measures, policies and programmes have to be implemented strictly to ensure good outcomes and only quality medicines has to be used and consumed through appropriate regulations.

There has to be adequate, comprehensive information and awareness on effects and impact of antibiotic resistance.

How can health professionals help in the prevention and control of antibiotic resistance?

They should ensure that the overall environment, the instruments and their hands are clean as this will prevent infections. They must follow current guidelines to prescribe antibiotics only when necessary. The surveillance teams have to be informed of antibiotic-resistant infections. It is equally important that patients are informed about how to consume antibiotics, the risks of misuse and overuse, and about antibiotic resistance. Also, educate patients about the importance of preventing infections by following measures like handwashing, safe sex, covering nose and mouth in sneezing and following up with vaccination.

How can the Healthcare industry help in preventing and controlling antibiotic resistance?

Healthcare industry should come forward and invest in R&D on vaccines, diagnostics, antibiotics, cutting edge technologies and other tools.

What is the role of the agriculture sector in preventing and controlling antibiotic resistance?

Antibiotics have to be given to animals only under the supervision of veterinary experts. Eliminate the use of antibiotics to prevent diseases or for growth promotion in healthy animals. Animals need to be vaccinated to curb the need for antibiotics and use alternatives to antibiotics.

Good practices need to be promoted and followed in the production and processing of foods from plant and animal sources. Improved hygiene and animal welfare are crucial in improving the biosecurity on farms and in preventing infections.

How to reduce infections?

Follow precautions like hand wash and hand hygiene, appropriate cough etiquette, get vaccinated, proper food safety methods, avoid mosquito bites and if you are travelling follow basic precautions to prevent and control infections.

What are the challenges in fighting antibiotic resistance?

India faces many challenges when it comes to tackling antibiotic consumption and antibiotic resistance. Most people seek antibiotics over the counter without prescription or sometimes pressure the doctor into prescribing antibiotics not realizing that overuse of antibiotics is leading to antibiotics resistance, which ultimately makes cure very difficult. Most people also do not know the side-effects of the use of antibiotics nor are they aware of the composition of antibiotics, which poses a risk to the health of the consumer. Awareness programmes on the appropriate use of antibiotics are also few and far.

There has to be an increase in educational and awareness programmes on the use of antibiotics and their effects. The primary aim of this campaign has to be to prevent the public from putting pressure on the doctors to prescribe antibiotics and from self-prescribing. If we take the example of viral fever, there is high pressure on doctors to prescribe antibiotics which leads to an erroneous prescription as antibiotics may not be effective against viral fevers. Despite this, if people consume antibiotics, it could lead to increased resistance. This stranglehold has to be broken by deploying certain strategies.

Over the counter sales of antibiotics should be stopped. A good strategy is to follow regulations the government has prescribed through plans suggested by medical bodies and associations as a result of which there is now a clear antibiotics policy on all aspects of its usage. This will help in building greater awareness on the use of antibiotics.

What is the way forward?

Antibiotics resistance is a major threat in the country and that apart from people themselves, medical institutions in both the public and private sector and the government as a whole have a great role to play in breaking this resistance. We have to keep in mind both the pros and cons of use of antibiotics before we prescribe them to patients. Sales of antibiotics in pharmacies should continue to be monitored by the DGCI. The use of antibiotics in animal and agricultural industry should be strictly supervised. We need to promote infection control practices in communities and hospitals as this would avoid unnecessary use of antibiotics.