Doctors warn against unjustifiable use of antibiotics, pill-popping | Mumbai news - Hindustan Times
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Doctors warn against unjustifiable use of antibiotics, pill-popping

ByPayal Gwalani
Dec 02, 2022 12:38 AM IST

Mumbai: India is among the biggest consumers of antibiotics in the world at an annual consumption of 10

Mumbai: India is among the biggest consumers of antibiotics in the world at an annual consumption of 10.7 units per person. In many cases, these medicines are abused or used irrationally causing high antimicrobial resistance (AMR) in the country as well.

Doctors warn against unjustifiable use of antibiotics, pill-popping
Doctors warn against unjustifiable use of antibiotics, pill-popping

To ensure the justifiable use of these medicines that the Indian Council of Medical Research (ICMR) has recently come up with guidelines for antimicrobial use in common syndromes.

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These guidelines suggest doctors to not use antibiotics in cases like a low-grade fever, viral respiratory infections, gastroenteritis and food poisoning. It also tells them to limit using these medicines empirically (based on symptoms) in a select few cases. These guidelines were devised based on the monitoring and surveillance of antimicrobial use in private as well as public hospitals in India over the last few years, and the resistance pattern seen in the domestic hospitals. This is the third edition of the guidelines, with the previous ones being issued in 2017 and 2019.

One of the contributors to these guidelines Dr Tanu Singhal, a consultant paediatrician and infectious diseases specialist from Kokilaben Dhirubhai Ambani Hospital, calls AMR the other pandemic that we are currently facing. “Until recently, we would follow international guidelines. The problem with that is that resistance patterns in developed countries are very different from those in India. This means that even when following the international guidelines, we were undertreating or overtreating infectious diseases,” she said.

As an example, she speaks about drugs like carbapenems and meropenem which work very well in the western world but 50% of the microorganisms found in our environments are resistant to them. The resistance rates are especially in hospital-acquired infections which are usually caused by ground negative organisms.

“It doesn’t help that we have a higher infection rate than most countries due to poor sanitation, insufficient hygiene, low immunisation and pollution. Irrational use of antibiotics like azithromycin which people can buy over the counter makes things worse,” she said. Another big contributor to this, she said, is the poor infection control practices in hospitals, lack of resources, lack of well-trained health workers or shortage of staff that lead to hospital-acquired infections. The objective of these guidelines is to educate doctors about when not to use antibiotics, and to use the right antibiotics that will be most effective in a given situation, she added.

A contributor to one of the chapters in the guidelines, an infectious diseases consultant at the city’s PD Hinduja Hospital Dr Umang Agrawal said that AMR, though a global concern, yet is a very local issue as epidemiology differs from place to place, making localised guidelines essential. “The guidelines will act as a ready reckoner for the doctors. They can also take help of a mobile application that has specifically been designed for this,” he said. The app, he added, can be used to generate the most optimal and effective drug prescription pattern when the doctor feeds in the details regarding the patient’s condition and symptoms.

Explaining the reason for restricting the use of antibiotics in cases of fever, he said that in 70-75% of the cases fever or cold are caused by viruses.

“These conditions are usually self-limiting, that is they get resolved without the use of drugs. Using antibiotics for these infections does not make sense,” said Dr Agrawal. When all doctors start emphasising that patients don’t always need medicines to get better, the attitude of the patients towards pill popping can be changed, he said.

He gives the example of his own hospital, saying that the hospital’s microbiology department has thorough data about the most common microbes in their ICUs. They have a local antibiogram that helps doctors in prescribing antibiotics optimally without misusing any medicines.

The doctors conclude that the patients also need to be more aware of the fact that AMR can harm the community at large. “We are running out of treatment options and not many new drugs are in the pipeline. If we do not use our existing antimicrobials wisely, we are destined to return to the pre-antibiotic era of untreatable infections,” said Dr Singhal.

WHAT IS ANTIMICROBIAL RESISTANCE

Microorganisms can develop resistance to an antimicrobial drug such that it is no longer useful to treat diseases caused by them. The organisms can thus become multidrug-resistant (MDR), extensively drug-resistant (XDR) or pan/ totally drug-resistant (PDR/TDR).

THINGS TO REMEMBER

Patients should not self-medicate, especially when it comes to antibiotics

Do not demand medicine when your doctor says you don’t need it

Do not share prescription drugs

Don’t use leftover antibiotics without first consulting a physician

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