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Submitted by PatientsEngage on 3 October 2017

Antibiotic resistance or Antimicrobial resistance(AMR) is emerging as a major threat the world over. With high prevalence of infectious disease and poor health care, India is the largest consumer of antibiotics. Dr. Camilla Rodrigues, Consultant Microbiologist & Chairperson Infection Control Committee, P.D. Hinduja Hospital, Mumbai, gives us an overview of antibiotic resistance.

Antibiotic resistance, a global concern, is particularly pressing in developing nations, including India, where the burden of infectious disease is high. What is antibiotic resistance?

Anttibiotic resistance is when bacteria acquires resistant mechanisms to overcome the effects of antbiotic drugs.

How does antibiotic resistance occur?

There are essentially 4 mechanisms:

  1. Inactivating enzymes (An existing cellular enzyme is modified to react with the antibiotic in such a way that it no longer affects the microorganism.)
  2. Impermeability (Some bacteria can resist antibiotics due to impermeability of their outer membrane)
  3. Efflux (Efflux pumps can expel a broad range of antibiotics)
  4. Altering the target site (Bacteria have found ways to alter the molecular targets of antimicrobial agents)

In 2010, India was the world’s largest consumer of antibiotics for human health. Are antibiotics overused in India?

YES.

The overall burden of resistance is mostly seen among infants and elderly. Can this imbalance be reduced or alleviated?

It is particularly difficult to overcome in extremes of age, immune suppression and in situations where patients are extremely sick - such as sepsis, organ transplant, cancer, etc

What kinds of infections are caused by viruses and should not be treated with antibiotics?

  • Tropical Diseases - dengue
  • Upper respiratory viral infections - Influenza
  • Diarrhoeal diseases - rota virus, etc

For which infections are antibiotics good? When should one take antibiotics?

  1. Only in proven bacterial infections
  2. Empiric therapy especially seriously ill patients who are likely to have a bacterial infections
  3. Perioperative Prophylactically in surgery

Is the antibiotic used in farm animals a threat to human health?

This is a great threat especially when used in livestock or when used as growth promotants or as prophylaxis. Also used in agriculture and fish farming.

What are the possible side effects that can be caused by antibiotics?

Serious side effects:

  • Bone marrow suppression,
  • Ototoxicity
  • Renal damage
  • Liver toxicity
  • Clostridium difficile (C. difficile) diarrhoea, etc

Less serious side effects:

  • Nausea,
  • Diarrhoea
  • Vomiting

How can the common man guard against developing antibiotic resistance?

Avoid taking antibiotics for what is obviously a viral infection. Antibiotics do not work on viral infection.

Recent update

A recent World Health Organization report—Antibacterial agents in clinical development–an analysis of the antibacterial clinical development pipeline, including tuberculosis—paints a scary picture of antimicrobial resistance (AMR). It says that those antibiotics, which are almost in the pipeline as far as research goes, will fail to combat the growing threat of AMR.

Most drugs currently in the clinical pipeline stage are modifications of existing classes of antibiotics and are only short-term solutions. This includes drug-resistant tuberculosis, which kills around 250,000 people each year. .

“Antimicrobial resistance is a global health emergency that will seriously jeopardise progress in modern medicine,” says Tedros Adhanom Ghebreyesus, director-feneral of World Health Organization (WHO). 

Read the article here

Update based on feedback from a PatientsEngage community member Lillian

Based on a recent opinion article published (July 26) in the journal The BMJ, there is a greater acceptance of shorter courses of antibiotics. But it is still important to follow the doctor's prescription (exactly as prescribed) and not decide on your own, since as a patient you have no way of knowing if the infection is cured or not.   

The verbatim response to the question on the WHO site 

Does stopping a course of antibiotics early lead to antibiotic resistance?

A: There has been a lot of research into how long antibiotic courses should be, to determine the shortest possible length of course needed to completely kill all bacteria.

If you are being treated for an infection, the kind of antibiotics your doctor prescribes and the length of the course should be based on the best evidence.

Feeling better, or an improvement in symptoms, does not always mean that the infection has completely gone. Your doctor has had years of training and has access to the latest evidence – so always follow their advice.

Evidence is emerging that shorter courses of antibiotics may be just as effective as longer courses for some infections. Shorter treatments make more sense – they are more likely to be completed properly, have fewer side effects and also likely to be cheaper. They also reduce the exposure of bacteria to antibiotics, thereby reducing the speed by which the pathogen develops resistance.

WHO publishes guidelines about treatments for different infections and recommends treatment durations and doses of antibiotics based on the best clinical evidence for each case. We continuously review the latest research so that we can provide updated recommendations to health professionals.

Dr. Camilla Rodrigues, Consultant Microbiologist & Chairperson Infection Control Committee, P.D. Hinduja Hospital, Mumbai - pic below