Thursday, August 27, 2015

Antibiotic the panacea that isn't

Thursday, August 27, 2015
My attention was drawn to this piece in the newspaper. In a significant development,"Britain has decided to penalize doctors who give in to patients' demands for the drugs that are fast becoming ineffective"
"The recommendation that doctors who prescribe antibiotics without good reason be liable for disciplinary action was made to UK's National Health Service by Centre for Clinical Practice, National Institute for Health and Care Excellence (Nice)."
"A British government-funded review recently recommended that pharmaceutical companies set up a $2-billion global incentive fund to look for new antibiotics. Not a single new antibiotic — known to be the magic bullets of medical science — has been discovered in over 30 years."
Every body who is engaged in patient care should sit up and take a note of how much expenses are involved in development of an antibiotic molecule and significantly nothing has come our way for decades! Antibiotics are the most potent tool that modern medicine has in its armamentarium. It is really very sad and disquieting to see how this potent weapon is being blunted every day by indiscriminate use. 

What is happening in india?

"The availability of health services in rural India is high and people seek care 96% of the time they are sick, however, conditions are poorly diagnosed and treatments are provided indiscriminately. Almost 80% of Indian prescriptions include an antibiotic, whether needed or not. Medical students learn this practice from seasoned physicians and, through mimicking senior doctors’ prescriptions, quickly adopt the view that it’s easier to give an antibiotic to ensure that you don’t miss something; diagnosis is rare and, even when one is made, a broad spectrum antibiotic is prescribed." 
The two important factors that weigh in the minds of prescribing doctors which out weigh all other factors are 1. The fear of missing something, so " cover" everything under the umbrella of antibiotics and thus have a false sense of security. It is another story that broader is the coverage larger is the chance of developing resistance. 2. If I  do not use antibiotics, a colleague will, and I shall lose my patient to him. And under this pretext, we give in to populist demands. Patients and physicians alike use antibiotics as fever lowering agents and as anti cough measures. Both of which they are not. Antibiotics are agents meant to work against specific bacterial infections only.
In paediatric population the 2 most common ailments for which antibiotics are abused are watery diarrhoea and upper respiratory infections , viral, more often than not. People have notions that their children do not get well and quickly  without use of antibiotics and doctors help to strengthen this false belief. Over the counter availability of many antibiotics hardly helps matter.
In paediatric population in an outdoor scenario, save infants less than 90 days, there is usually time to come to a reasonable diagnosis without inflicting any harm to the children by waiting for the diagnosis as the disease evolves.When not using antibiotics the responsibility is even larger to keep educating people about the danger signs and to report quickly back if anything goes amiss. Many a times an hurried institution of antibiotics is likely to mask the diagnosis( for example an urinary tract infection) and then proper duration of treatment is difficult to institute.
Judicious and appropriate antibiotic usage is in larger interest of the people.Unwanted and injudicious use of antibiotics is the most important underlying cause of developing resistance to them by the bugs which once were responsive . (People generally erroneously think  it as lowering of resistance of the person who takes antibiotics.) We  already have "super-bug" causing havoc, and many a times we are left searching for an available antibiotic in very critical patients.
Multi drug resistance tuberculosis has already become a menace, a very difficult and expensive preposition. The mindless usage of antibiotic from the group of  quinolones ( in children mostly and generally unnecessarily for diarrhoeal illnesses) is to be discouraged strongly because this group is quintessential for management of resistant cases of tuberculosis. 
One educational exercise which can go a long way against abuse of antibiotics is demystifying fever.


  1. The main reason why the resistance develops is inadequate course and duration rather than inadvertent use of antibiotics,
    Often early recovery from symptoms makes one stop the medicines; as they are not counselled why not to in each visit,
    Standard reason given by parents is that the bottle got over, as often say fro example amoxicillin combination bottle of 30 ml gets over in 3 days and if symptoms get relieved; there is reluctance to buy new bottle when the course is 10-14 days duration.
    Often many doctors too write short course of 5 days for such an antibiotic which is likely to cause in adequate cure. .. hence overuse and hence resistance.

    So it is important to take action against doctors who write inadequate course rather than empirical therapy which at times may be justified in given situation in India.
    empirical use can be minimised by training doctors when not to use or when to sue antibiotics, say in a case of sore throat refer the link:
    Also there is a need to initiate pharmacists to dispense and pharma companies to provide say a 4 bottle box as per duration of therapy , so the short course use is likely to be minimal.

    click below to read basic counselling related to antibiotic use for general public.