Antibiotics: A war that we are losing
The indiscriminate use of antibiotics leading to drug resistance is the new challenge doctors in emergency care are grappling with. More lives are being lost to non-life threatening illnesses such as typhoid and common chest infections such as pneumonia as these are becoming harder to treat due to antibiotic resistance.
“Around 35% children referred to the advanced paediatric centre of PGIMER with community acquired infections such as pneumonia, meningitis and urinary tract infections were found to be on high-end antibiotics such as carbepenem and vancomycin even though these diseases can be treated with simple antibiotics such as amoxicillin, ceftriaxone, ampicillin. As a result, the higher-end antibiotics are becoming ineffective in treating life-threatening infections such as severe sepsis with septic shock,” said Dr Jayashree Muralidharan, head of paediatric emergency, PGIMER.
Over-the-counter sale to be blamed
Dr Muralidharan added that India is a leading capital of anti-microbial resistance because of the uncontrolled use of antibiotics. “There is no stringent policy and control to check over-the-counter sale of antibiotics. This eventually leads to their injudicious use,” she said.
Doctors running out of antibiotics
The most common children’s diseases in which antibiotics are misused are respiratory viral infections such as flu, cold and bronchitis. “We are running out of antibiotics and have reached a stage where most of the antibiotics have become resistant and doctors in the emergency care are at their wits end to find the right drug to save lives. We are heading towards an era like ‘pre-antibiotic era’,” Dr Muralidharan said.
“There are situations when doctors find severe life-threatening infections difficult to treat because high-end group of antibiotics such as Sulbactam, Carbepenem, Cephalosporins have become resistant. The only ‘magic pill’ probably left with us is Colistin, which is also gradually becoming resistant,” she further revealed.
Dr Vikas Gautam, professor, department of microbiology, PGIMER, said, “In the 1950s, doctors started using Colistin but they stopped in the 1980s because of its side effects like kidney ailments. But all antibiotics discovered after this have become resistant and doctors are left with no option but to start using it again. But even Colistin has now started getting resistant.”
Drug resistance: infections taking longer to cure
He added, “Typhoid, which used to be cured in 5 to 7 days is now taking at least two weeks. Earlier, only one antibiotic (septran) was used, but now even two antibiotics (cefixime and ciproflexim) together take longer to cure.”
“Antibiotics are not meant for viral infections. Every time one takes antibiotics, it destroys the good gut bacteria,” Dr Gautam said.
Dr Arunaloke Chakrabarti, head of medical microbiology, PGIMER said, “All patients referred to emergency are already given imipenem (high-end antibiotic). Now what will a doctor in tertiary care give when those in periphery have already given high-end antibiotics?”
He said that because of the deficiency of laboratory services, doctors are immediately going for antibiotics. “Then they give a broad spectrum antibiotics, which mean they kill all types of bacteria. Then they do not know when to stop antibiotics, what is the correct dosage. So, these way doctors are misusing the antibiotics,” Dr Chakrabarti said.
Self medication and prescription of antibiotics by ayurvedics and rural medical practitioners who have no knowledge about this is doing a lot of harm. Then use of antibiotics in animals, poultry, cattle and use of use of pesticides should be under check.