Punch on antibiotics

Increased use of antibiotics makes them less effective, says Dr aparna kotekar

The abuse of the class of drugs antibiotics, which once had revolutionised treatment of bacterial infections and caused a significant reduction in morbidity and mortality, has today become a grave healthcare challenge. In 2010, India was reported to be the world’s largest consumer of antibiotics.

A 2018 study published in the Proceedings of the National Academy of Sciences reported that the antibiotic consumption in India had more than doubled from 2000 to 2015. Thus, ironically, better access to antibiotics has resulted in its overuse and misuse, leading to increased cases of antibiotic resistance. Therefore, it is important that there is mass awareness on the growing threat of the condition.

The reasons for increasing antibiotic resistance in India are manifold. They include inappropriate use of antibiotics, widespread availability of antibiotics without prescription resulting in self-medication, empirical antibiotic treatment rather than evidence-based treatment, low healthcare spending, prevalence of counterfeit antibiotics resulting in sub-optimal dosing, high frequency of incomplete antibiotic course especially among the lower income group where antibiotics are used for symptomatic relief instead of microbial eradication

• Reasons: Bacteria become resistant when they are exposed to antibiotics. Drug resistance develops either by acquisition of genes that are responsible for inactivating antibiotic molecules or by target gene mutation. The former is especially dangerous as it can spread quickly by horizontal gene transfer. Thus, antimicrobials become ineffective leading to persistent infections, and ultimately result in the spread of these resistant microbes in the community.

As per the World Health Organisation’s (WHO’s) “Antimicrobial Resistance — Global Report on Surveillance” of 2014, the incidence of resistance in common pathogens like E. coli, K. pneumoniae and S. aureus was about 50 per cent. This is quite alarming considering that no new antibiotics have been developed in the last four decades. Thus, AMR has become a global health crisis which could render even common infections untreatable with existing antibiotics.

• Prevention: Studies have shown that around 50-60 per cent of antibiotic prescriptions are unnecessary. That is, antibiotics are prescribed even when the cause of infection is unknown. For example, antibiotics may be prescribed when the patient has a viral infection or the wrong antibiotic may be prescribed in the absence of identification of the infecting bacteria.

Evidence-based use of antibiotics can go a long way in stemming the spread of AMR. For this, detection of the pathogen and antibiotic resistance patterns is absolutely critical. Currently, this is done by microbial culture and sensitivity which can easily take around 72 hours for bacteria and longer for fungi.

Besides, microbiological methods show false negativity in patients pre-treated with antimicrobials, and have low sensitivity for slow growing, intracellular and fastidious microbes. In the time taken to diagnosis, empirical broad-spectrum antimicrobial therapy is administered, especially if the patient is critical, favoring selection and spread of resistant pathogens, and increased invasive fungal infections.

Molecular methods can overcome the limitations of microbiological methods, reducing the time to results in identifying pathogens and antibiotic resistance. As a result, it can serve to reduce the spread of antibiotic resistance, reduce healthcare costs by reducing consumption of expensive 3rd-line drugs, reduce ICU/hospital stay and result in better patient outcomes.

The writer is HOD, Molecular Department, Genetic Diagnostics