Rational Antibiotic Awareness Day
Dr Ravinder K Gupta &
Dr Harsh Vardhan Sharma
“ANTIBIOTICS” are the chemical substances that fight bacterial infections in people and animals. They work by killing the bacteria (bactericidal) or making it hard for them to grow and multiply (bacteriostatic). Antibiotics can be taken orally, topically, or intramuscularly/intravenously.
The very first antibiotic was discovered by Alexander Fleming in 1928, and it was Penicillin. In 1930s first commercially available antibacterial was launched with the name Prontosil, a sulfonamide developed by German biochemist Gerhard Domagk. Penicillin was introduced on large scale as a treatment for bacterial infections in 1945. This introduction of penicillin marked the beginning of the so called “golden era” of antibiotics. Currently we have hundreds of antibiotics discovered till now.
Antibiotics are advised for various usual and life-threatening conditions. Antibiotics are prescribed on the basis of susceptibility of the target bacteria and mechanism of action as the gamut of bacteria it is going to cover.
In India, antibiotic use has been rampant owing to easy availability, malpractice and lack of awareness about its use among the general public. ‘Self-Medication’ is one of the most significant contributors to this widespread use. It includes medication by self, by a close friend, by a previous prescription, by social media and on a phone call by family physician.
World Health Organization defined “Rational Use of Medicine” as using correct medications that are relevant to the clinical requirements of the patients, in exact doses according to the individual needs, for a sufficient duration of time and at the lowest cost to them. Several studies in different countries have hypothesized that the behavior of rational antibiotic use was related to several factors such as age, gender, educational status, level of household income, health insurance, and knowledge about antibiotic use of the participants.
As we all know antibiotics are useless in viral infections (common cold, dengue fever, measles, mumps, etc. ) which are self-limiting, differentiating it from bacterial illness is of utmost importance. Proper time should be given to each patient with a history examination and relevant investigations before starting him/her on a proper line of treatment. Once decided on prescribing the antibiotic, the use of the proper class of drug with the recommended dose and duration should be advised. It should be well informed in advance about the importance of following proper dose and duration to avoid emergent antimicrobial resistance.
Antimicrobial resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produces 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) and age dependent changes of a developing system of different enzymes determine a rather diverse population in terms of biochemical characteristics and pharmaco kinetics profiles, hard to easily codify in an age or weight- dependent dosages.
Strategic Objective 4 of the Global Action Plan [an Anti microbial Resistance (WHO)] advices to optimize the use of antibiotics in human and animal health
* To reduce inappropriate use is key to keep antibiotics effective, and is an important element of a national action plan.
* At the same time, a large proportion of the world’s population lacks access to effective antibiotics. Increasing access to antibiotics is, therefore , also essential, but the needs to take place within a framework of rational use.
Rational use of antibiotics is the practice of using antibiotics safely and effectively to treat bacterial infections. It involves: Choosing the right antibiotic: Using the most suitable antibiotic for the infection. Administering the correct dose: Using the optimal dose based on accurate information about the medicine .Following the correct schedule: Taking the antibiotic at the correct frequency and for the correct duration. Using the right route: Administering the antibiotic using the most suitable route.
The goal of rational use is to: Minimize the development of antibiotic resistance. Maintain the effectiveness of antibiotics. Ensure that antibiotics are used appropriately. Ensure that people have access to effective antibiotics. The rational use of antibiotics is important because:All antibiotic use can contribute to the development of antibiotic resistance. Antibiotics are a finite resource. The benefits of antibiotics must be balanced against the risks to patients and society
All antibiotic use, whether appropriate or not can promote the emergence of resistance in bacteria. Unfortunately, inappropriate and excessive use of antibiotics is common in both high- and low-income countries, and in both the human and animal sectors. Limiting the inappropriate use of antibiotics is crucial to preserve antibiotic effectiveness for both human and veterinary medicine.
Antibiotic resistance gives rise to Superbugs which can be bacteria, viruses, parasites, or fungi that are resistant to multiple antibiotic medications. Infections by superbugs are hard to treat and can lead to life threatening infections. Each year these superbugs infect more than 2 million people nationwide and kill at least 23,000, according to the U.S. Centers for Disease Control and Prevention.
Way forward can be divided into individual level and government level. Individually, public should stop self-medication, consult a doctor before starting such medication and follow the advised dose and duration very meticulously even when the patient becomes alright with just one dose. At the level of the government, stringent laws should be made in place curbing the menace of over-the-counter antibiotic sale and also making the doctor accountable for the antibiotic prescribed by him/her.
Looking at the pace of antibiotic resistance and emergence of new superbugs, strict actions needs to be taken as soon as possible otherwise near are those days when a simple skin boil will lead to fatal septicemia. Thus, yet again dragging the world into Pre- Antibiotic era.Inappropriate use of antibiotics can have negative health consequences, including: bacterial antibiotic resistance, treatment inefficiency, increased morbidity and mortality, and increased health care costs.
As we are celebrating the Rational Antibiotic Day on 28th September and a week thereafter, here is a mnemonic RATIONALE to fit in some aspects of rational prescribing practices: R-Reasoning for prescription, Right dose, route, duration; A-Academically updated decisions; T-Training of mind, doctors , parents, pharmacists; I -Instructions to patients ; O-Organism search; N-Noting down the diagnosis; A-Antibiotic Policy; L-Local sensitivity pattern; and E-Ethical considerations, Economic condition of the patient
Let us ensure that we do not get infected with the Human Irrationality Virus (HIV) out of habit, ignorance and varying factors like pressure from pharma, our ego and callous attitude about antibiotic resistance. Until recently, recognition of new resistant clones was balanced by the promise of newer and more potent antibiotics. Today fewer new classes of antibiotics are under development, and clinicians are facing limitations in their ability to treat some serious bacterial infections. Let us be rational every day and enjoy REM sleep daily by developing a Rational Ethical Mindset.
Every year ‘Rational Antibiotic Awareness Day’ is celebrated on September 28 followed by Awareness Week from September 28th to October 4th. The theme for ‘Rational Antibiotic Awareness Day & Week’ this year is ‘Think Smartly, Write Wisely & Educate, Advocate, Act Now’.
(The authors are from Department of
Pediatrics, Acharya Shri Chander College of Medical College (ASCOMS), Jammu )
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