Antibiotics are life-savers. They have been used since the late 1940s to treat infections caused by bacteria. Since then, they have developed by leaps and bounds. Of course, antimicrobials aren’t magic pills that can heal every disease. But when used at the right time, they can be the difference between life and death.
However, every coin has two sides to it. The impressive success of antibiotics has been tempered by the phenomenon called antibiotic resistance. This happens when the bacteria develop the ability to defeat the drugs against them. Antibiotic resistance does not mean that the body is becoming resistant to antibiotics; it is that bacteria have become resistant to the antibiotics designed to kill them.
When a child is sick, the parents are stressed and worried. Even if it is just a common cold or a sore throat, it makes the child cranky and restless. This is followed by a visit to the paediatrician where the parents expect to come out of the office only with a prescription in hand. But the doctor often examines the child and perhaps some tests later deem antibiotics unnecessary. Many parents are surprised by this decision. The all-powerful antibiotics have been saving lives, easing suffering and serving mankind faithfully for generations. But most doctors aren’t as quick to reach for their prescription pads as they once were. In recent years, they’re realizing that there is a downside to choosing antibiotics – if these medicines are used when they’re not required or they’re taken incorrectly, they can pose a greater risk to public health.
A rather well-known example – the carbapenemase secreting bacteria christened as “New Delhi Superbug” which had shocked the world by spreading to almost 100 countries. These bacteria were resistant to not only the regular antibiotics but also the ones used as the last resort to treat bacterial infections such as carbapenems. This incident had caused alarms to be raised all over the globe advocating for increased emphasis on careful antibiotics usage.
In light of such troubled circumstances, the 1990s saw the emergence of various programmes implemented worldwide under the broad term “antimicrobial stewardship”. According to the Center for Disease Control and Prevention (CDC), antimicrobial stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. It revolves around the concept of 4 D’s of optimal antimicrobial therapy – right Drug, right Dose, right Durationand De-escalation to pathogen-directed therapy. The central theme of this stewardship also includes prevention of antimicrobial overuse, misuse and abuse. The ultimate goal is to reduce antimicrobial resistance by following such protocol and application of valid research.
Multi Drug Resistant (MDR) microbes are on the rise and it is up to us, the medical fraternity to take a stand against this issue. An effective stewardship team must be formed in every hospital in close collaboration with the staff of the microbiology laboratory, hospital epidemiology and administration to implement a well-functioning program. Infection control procedures coupled with local antimicrobial resistance guidelines will be of immense value. By making antimicrobial stewardship part of our daily practice, we can improve patient safety and care, diminish the unnecessary use of valuable resources, and thereby reduce antimicrobial resistance.
Malik, B., Bhattacharyya, S. Antibiotic drug-resistance as a complex system driven by socio-economic growth and antibiotic misuse. Sci Rep 9, 9788 (2019). https://doi.org/10.1038/s41598-019-46078-y
Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011; 86:1113–1123. doi: 10.4065/mcp.2011.0358
Eshwar Rajesh is pursuing MBBS from Madras Medical College, Chennai, India. He has an exemplary academic record and impressive extracurricular talents. He is a national level swimmer and a skydiver, winner of various quizzes and seminars in state and national level competitions. He held the Limca National Record for being the youngest advance open water scuba diver in India. He speaks 7 languages and is passionate about medicine and music.