Indiscriminate use of antibiotics is one of the factors responsible for the rising antibiotic resistance in India [1]. The World Health Assembly in 2005 sent a call for rational use of antimicrobial agents to curb the problem of rising antimicrobial resistance [2]. Many strategies have been advocated to counter the ever increasing threat of antimicrobial resistance. One such strategy is antimicrobial stewardship [3]. One other important aspect that is a major determinant of appropriate use of antibiotics is the availability of antibiotics.

The overall prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients in India is about 40-50% [4,5]. Although MRSA prevalence is on the rise, Methicillin-sensitive S. aureus (MSSA) continues to be the more common type of Staphylococcus. For MSSA bacteremia, early adminis-tration of beta-lactams is crucial as empirical Vancomycin therapy for MSSA bacteremia is associated with increased risk of morbidity and mortality compared to an anti-staphylococcal penicillin (oxacillin and nafcillin) or first-generation cephalosporin (cefazolin) [6]. Waiting for culture reports also would be deleterious as delays in initiation of antibiotics for staphylococcal bacteremia have also been associated with an increased odds of infection related mortality [7]. Given this background, the non-availability of Cloxacillin, especially in the private sector hospitals, makes it difficult to treat a patient with MSSA (especially the strains resistant to penicillin but sensitive to oxacillin). Treating doctors are forced to use combinations as ampicillin-cloxacillin or costlier drugs like amoxycillin-clavulanate despite knowing that these are not ideal. Moreover, at times, they are forced to use therapeutically inferior drugs such as Vancomycin [8] or drugs reserved for resistant organisms like Linezolid. Thus, non-availability of antibiotics also paves way for irrational use and hence may defeat the antimicrobial stewardship efforts. Through this letter, we would like to forward our plea to the policy-makers to take into account this important issue and make all first-line antibiotics available by strict regulations.

1. Yewale VN. IAP-ICMR call to action to tackle the antimicrobial resistance. Indian Pediatr. 2014;51:437-9.

2. Leung E, Weil DE, Raviglione M, Nakatani H. The WHO policy package to combat antimicrobial resistance. Bull World Health Organ. 2011;89:390-2.

3. Bedi N, Gupta P. Antimicrobial stewardship in pediatrics: An Indian perspective. Indian Pediatr. 2016;53:293-8.

4. Indian Network for Surveillance of Antimicrobial Resistance (INSAR) group, India. Methicillin resistant Staphylococcus aureus (MRSA) in India: Prevalence and susceptibility pattern. Indian J Med Res. 2013;137:363-9.

5. Senthilkumar K, Biswal N, Sistla S. Risk factors associated with methicillin-resistant Staphylococcus aureus infection in children. Indian Pediatr. 2015;52:31-3.

6. McConeghy KW, Bleasdale SC, Rodvold KA. The empirical combination of vancomycin and a â-lactam for Staphylococcal bacteremia. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57:1760-5.

7. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis Off Publ Infect Dis Soc Am. 2003;36:1418-23.