Antibiotic Use, Misuse Raise of SUPER-BUGS?

Dr.T.V.Rao MD
Antibiotic misuse is a great concern, Microbiologists working with true spirit are the first
people to observe the growing drug resistance patterns, today we have many K. pneumonia arising
from chronically ill patients and many are presenting as hospital acquired infection, Increasing
number of strains are resistant to 3rd generation cephalosporins and we are testing for sensitivity
patterns to carbapenem group of antibiotics resistance with Imipenam and Meropenam is a
Universal concern , The fact is that we are soon approaching a stage where you as an individual will
know someone who died of a drug resistant infection. Ten years ago we didn't really have many
issues with carbapenem resistance in gram negatives and now we have a class of bacteria called
entro-bacteria popularized with NDM strains and we have very common carbapenem resistance. A
sample survey conducted by the World Health Organization in New Delhi in April 2011 revealed that
more than half (53%) of Delhi-ites surveyed self-prescribe antibiotics. One in four of those surveyed
stop taking them once they felt better, instead of finishing the entire course. Another one in four
Delhi-ites (25%) treat regular fever with antibiotics, and 18% of those surveyed re-use antibiotics in
the family. According to the study, 16% to 18% physicians said they prescribe antibiotics for non-
specific fever, cough, and even diarrhoea. We discuss many matters in the Institutional practices at
our Medical colleges, the above said survey shows most of the patients are experimented with
newer generation of drugs before he comes to the Institutional care, it will lead to a situation that
the people are coming to our Institutions loaded with drug resistance bacteria, I do not know where
our teachings will stand in Antibiotic policy as we cannot be rational and many patients are being
treated with irrational therapies before they reach the hospital. Practically clinical Medicine is dying
in India rapidly even for trivial conditions ultrasounds and elaborate investigations are done
forgetting that their clinical will be supported by diagnostic protocols. In Recent interaction with
Doctors at our hospital everyone has his own vision on the use of Antibiotics, and blame there are
no effective Microbiology Diagnostic guidance and fully agree, in the Government and private
Medical colleges, have least investments are done on Microbiology Departments, as it is not Income
generating department, I feel it is time to realize that the matters are out of control, in future many
patients with trivial infections will perish with drug resistant strains, We have few options other
than, implanting and educating the Doctors on the National policy, or rationalist antibiotic use, as
the national policy could regulate the over the counter sale, enforce, and regularly keep a tab on
strong infection control measures at the hospitals across the country. More importantly, it make
pharmacists, doctors, medical professionals, and healthcare institutions alike accountable for it. It
will save lives across all age groups and demographics and from many diseases. Until then, it just
remains Indias uncomfortable and real truth. Never forget we are all responsible for the trends in
change as we thought the magic bullet is the solution, and bullet may kill the microbe and men too.
Major peer reviewed studies prove that misuse of Antibiotics are attributed to
1 Nexus between pharmaceutical industry and busy practitioners with freebies, foreign travels for
specialists and sub - specialists called as SUPER SPECIALISTS
2 Doctors running their own laboratories and Chemist shops and putting the patients to unnecessary
investigations
3 Lack of basic knowledge on antibiotics, many times guided by Medical reps
4 Treating the patients with minimal or no clinical l Diagnosis with no idea on what they are treating?
5 Above all patients ignorance to accept whatever the doctors are doing
6 Many of the senior microbiologists and Professors leaving the matters to Technicians and junior
faculty lead to all vagaries in the Laboratory science.
If the matters are not understood and effective regulations are not brought in patients in ICU and
critical care areas will be at highest life threat and even many critical are areas to be closed with
raise of SUPER-BUGS?
Dr.T.V.Rao MD Professor of Microbiology Travancore Medical College Kollam