Antimicrobial resistance (AMR) is a global problem
with serious regional impacts. We are on the verge of being thrown back
to preantibiotic era. We are running out of antibiotics, especially
those active against Gram-negative bacteria. Although there are several
reasons for use and abuse of antibiotics, a major cause of increasing
AMR is misuse of antibiotics by us – clinicians in individual practice.
This irrational antibiotic use has led to multidrug-resistant infections
like Extended spectrum beta-lactamase (ESBL) urinary tract
infection/sepsis, Multidrug-resistant tuberculosis, Extensively
drug-resistant tuberculosis (XDRTB), Multidrug-resistant typhoid fever,
and New Delhi metallobetalactamase infections.
The medical fraternity appears to have woken up to
the reality of multidrug resistance in old diseases like tuberculosis,
malaria and typhoid, and to the call for an urgent introspection and
finding out a solution. Indian Academy of Pediatrics (IAP) has taken a
serious note of the menace of AMR and the threat to mankind by the bugs.
The five-year plan announced by the IAP envisages training of fellow
pediatricians and postgraduate students through various CMEs and
workshops about rational antibiotic use. The plenary session at the
Pedicon 2014 at Indore discussed the magnitude of the problem of AMR,
the reasons behind, the way forward and the role of IAP. Workshops on
Rational Antibiotic Practice under the IAP action Plan program is
certainly a step in the direction of minimizing the antibiotic misuse.
Recognizing the role of medical tutors casting a long lasting impression
on the minds of postgraduate medical students, it is prudent to sow the
seeds of rational antibiotic practice during their training. This
workshop – designed by consensus among experts – should become a part of
the postgraduate curriculum.
IAP also needs to engage into a dialogue with
regulatory authorities and curb over-the-counter availability of
antibiotics, prevent marketing of irrational antibiotic combinations,
and control marketing of sub-standard drugs. The responsibility of not
falling prey to incorrect incentive-driven marketing strategies by
pharmaceuticals lies with us. Preventing AMR involves encouraging
rational antibiotic therapy at individual, hospital and community level.
IAP has declared 26th September as the ‘Rational antibiotic day’, and
plans to celebrate antibiotic awareness week.
A joint meeting of medical societies in India was
convened as a pre-conference symposium of the 2nd Annual Conference of
Clinical Infectious Disease Society (CIDSCON 2102) at Chennai in 2012. A
road map to tackle the global challenge of AMR from Indian perspective
was discussed. IAP plans to have a meeting on similar lines and involve
all the stakeholders to formulate a national policy on rational
antibiotic practice in pediatrics.
For policymaking and implementation of various public
programs to combat the problem of AMR, it is extremely important to have
sound data. It is unfortunate that in view of scarcity of such data,
various conclusions about efficacy of interventions need to be
extrapolated from experience of other countries. A sensitive
surveillance system is required to document and track resistance.
Antibiotic stewardship is commitment to use
antibiotics only when these are necessary to treat – or sometimes
prevent – infections, by choosing the right antibiotics and administer
them in the right way in every case. Every institute should have an
antibiotic policy. While we inculcate the culture of culture-based
diagnosis, laboratory facilities need to be scaled up. Good laboratory
backup is essential to understand the culture-sensitivity trends in
enteric fever, staphylococcal infections, tuberculosis and
Escherichia coli infections where the threat of multidrug resistance
appears to be growing day-by-day. Interactions between clinicians and
microbiologists, in rationalizing the antibiotic therapy, cannot be over
emphasized. Non-culture methods of establishing diagnosis need to be
explored and made available; their appropriate use should be encouraged.
Strategies to control nosocomial infections and prevent spread of
resistant infections are equally important and cost effective. Improving
immunization coverage and introduction of new vaccines have tremendous
potential of saving antibiotic use.
Pediatric infectious diseases have not yet officially
been recognized as a specialty in India. Since the last two decades, the
pediatricians have increasingly become sensitized to the need for
information and constant update on various aspects of infectious
diseases, including applied clinical pharmacology and immunization. IAP
established separate Chapter of infectious diseases in 1997 under the
pioneering efforts of Dr TJ Jacob John. Since then, infectious diseases
have been discussed in towns, state and national levels through CMEs and
conferences and the activities of the Chapter have grown in popularity.
The quarterly journal on pediatric infectious diseases was started with
the similar purpose of spreading and sharing knowledge, and
brainstorming over various issues in infectious diseases. Considering
the ever-changing trends of infectious diseases and challenges like drug
resistance, there is a need for a specialized formal training in this
specialty to increase the manpower trained in their diagnosis and
management. Though fellowships are available abroad, the spectrum of
tropical infectious diseases and local host-environment interaction
factors differ in Western countries.
Continued medical education to update and promote
rational use of drugs in the rural and urban regions is of paramount
importance. Unless each medical practitioner thinks twice about the need
and choice of the drug before penning the prescription, the battle
against resistance will be like flogging a dead horse.