Indeed it is a cultural problem. All health professionals have to work together to let patients know that viral infections are not naturally treated with antimicrobials. If an antibiotic is prescribed, the patient has to follow the instructions regarding the dose and duration of treatment. A drug suitable for a friend or a relative might be harmfull to another person. It is not recommended for any person to use antimicrobials as prophylactic drugs, except in a few cases that only physicians know, etc..etc...

Pharmacists, who have time to talk to the patients and who are trusted by them , have a great job to do regarding this issue.

Dear Ashok

This is a cultural problem and depends on customs and social behavior of a society.

Its necessary an action of Government with public politics of informations about the danger of drugs self administration .

Dear Ashok,

we are already bearing the brunt of irrational antibiotic use..... every day we juggle with treatment protocols where oragnisms are susceptible to only colistin and the emergence of colistin intrinsically resistant bugs while on colistin containing antibiotic regimens!

Doctors are not the only reason .. I agree with Nelson, it is a socio cultural issue and not an easy one to resolve. Yet only pointing fingers wont take us much far...each of us must work towards appropriate use of antimicrobial agents within our fields and never miss an opportunity to bring out the problem to sensitize the others

Ensuring rational prescribing is becoming more serious and it is further worsening where there is provision of law and regulatory body but everything non functional. This is more relevant in case of LDCs. Medical practitioners also wants patients to come again and attitude is that they don't want to take the risk and gives multiple medicines that acts for, for example, Viral as well Bacterial infections both. Fact is that viral infections will be cured in 7 days if medicines are taken and will be cure in 1 week if no medicines used. Thanks to god (for those who believe in it) for saving the lives if millions in pain.

Dear Nelson, Aruna and Deepak,

I really appreciate your comments.

I never meant Doctors are the only reason. I just meant we have to be responsible.

Yes, it is a cultural problem and We all are equally responsible for it.

But how do we cope with this problem ??

How can the use of Antibiotics be made rationale ???

How can we step forward for the prevention of the possible Disaster ???

Thank You.

Indeed it is a cultural problem. All health professionals have to work together to let patients know that viral infections are not naturally treated with antimicrobials. If an antibiotic is prescribed, the patient has to follow the instructions regarding the dose and duration of treatment. A drug suitable for a friend or a relative might be harmfull to another person. It is not recommended for any person to use antimicrobials as prophylactic drugs, except in a few cases that only physicians know, etc..etc...

Pharmacists, who have time to talk to the patients and who are trusted by them , have a great job to do regarding this issue.

It is indeed worthy to note the young scientists are bringing this issue. In the presence of Conscious doctors, conscious patients and conscious society, the problems will decline. In general, the attitude did not change among people who are aware of the problem. What about the rest. Tackling the problem is not easy. Where to start, when to start and how to start. We just can not lay the responsibility on the Government. An integrated approach is awaited. Lalitha Kabilan

In this situation we can go for bacteriophages introduced by russians 40 years ago, recently popularising,expecting more ways of modes of administration.

l beg to differ on the suggestions that it is a cultural issue. It is basically accessibility issues. In Europe, people do not have access to antibiotics on the markets, and for that matter they do not get tempted to misapply it since it is not available in the first place. There have been situations where physicians have been threatened by patients to prescribe antibiotics due to the belief that it might alleviate suffering. That is why even in Europe where antibiotic resistance is not yet a big problem, governments have set up a fund to educate and more importantly discover new and potent antibiotics. Pharma will not help, since they are in for the money. The onus falls on all health practitioners with support from governments. That is the only way l think.

Thank You All for your Opinions.

I believe We(physicians) should do our Job and try our best to be sensible and should never stop Counselling with the Patients. Yes, The Government do play a vital role. But, we just can hope they come out with Effective Plans to avoid such disasters.

With Regards.

Dear Manivannan,

Bacteriophages have several characteristics that make them potentially attractive therapeutic agents. They are (i) highly specific and very effective in lysing targeted pathogenic bacteria, (ii) safe, as underscored by their extensive clinical use in Eastern Europe and the former Soviet Union and the commercial sale of phages in the 1940s in the United States, and (iii) rapidly modifiable to combat the emergence of newly arising bacterial threats.

In addition, a large number of publications, suggest that phages may be effective therapeutic agents in selected clinical settings. Granted, many of these studies do not meet the current rigorous standards for clinical trials and there still remain many important questions that must be addressed before lytic phages can be widely endorsed for therapeutic use.

Thank You.

As you may be aware that the picture in developing countries including India is quite horrible. Self medication, Over the counter sale of drugs, large number of quacks prescribing, day to day increasing tendency of symptomatic prescriptions actually without assessing the need of antibiotic, inappropriate dosage and presence of grey market in pharma industry: are few factors can be held responsible. And we hope only God can cure this problem.

Making antibiotics therapy rational will involve restricted access, education of both the prescribers and patients, good knowledge of PK/PD of the drugs by prescribers, and prescribing the right dose for the right indication for the right duration and by the right route.

In many countries you don't even need a prescription to buy antibiotics!

Rational use of antibiotics is the need of time . People use them, without any expert advice, so accessibility should be restricted as discussed before . Govt plays an imp role here! Besides, sometimes they are prescribed too inadvertently, so that should be avoided and patient's body should be given some chance to fight. Many of the viral infections take their own short time to get controlled but still the patients are on antibiotics.

Rational use of antibiotics is a multifactorial problem. Pharmaceutical companies want to sell their products so they don't really care about this problem because the resistance to antibiotics will bring new molecules with more money to them (even if there is 1% improvement of the previous antibiotics!). Governments don't want to spend money for education, and this is clear nowadays, so, do not expect any improvement from this side. Patients do need education that can come through their doctors and pharmacists. Pharmacists also want to sell their products because that means profit, and if there are no rules for antibiotic prescription, then everyone can buy everything on the market. The big problem is also between doctors. They can prescribe a strong antibiotic (e.g. Ciprofloxacin) for a simple community-UTI infection, and most of the times with no cultures. So they choose to "kill a mosquito with a bazooka" rather than use the correct weapon. There are doctors who care about their patients and use the correct antibiotic. But let's be realistic. In countries that there is no education, if the patient goes to a doctor and he doesn't prescribe an antibiotic, then the patient will be dissatisfied and probably will go to another one and he will get "the correct treatment"!! So, the first doctor probably will do the same next time... I am not telling that this is correct, but it happens... Education is the solution... Explain to your patient clearly if there is no need for antibiotic prescription. Some of them will understand..

Irrational and even irrelevant use of antibiotics mostly causing resistance, at the same time full course incompletion leads to resistance. Doctors are prescribing even higher generation antibiotics along with Steriods withour proper judging and only for their reliability and dependency....this in the long run affecting resistence of certain antibiotics.Local Govt regulatory along with Drur Regulatory can strictly get proper action against them.

Yes indeed. Everyone needs Education- The people running The Government, public, pharmacist, and the physicians. Looks like "Patience" is the only Answer. But if the government is not investing in the policy making, what can we do from our side?? We can't just hope for something to happen and expect the government and pharmacist to become more responsible and publics becoming more educated. Dear Arnold, I really appreciate the concept of "The European Antibiotic Awareness Day". We seriously need something like that especially in the developing countries where the scenario is even worse.

This is a complex problem and therefore requires a multifaceted approach to deal with it. While programmes for general awareness in public and patient will be handy, necessary changes must be brought about in education and training of all sectors of healthcare professional, including doctors, pharmacists, nurses etc. To make these things work effectively, strict policies and guidelines must be place and this is where governments have to play a formidable role.

Another major problem is the indiscriminate use of antibiotics in food animals with resultant high antibiotic residues in edible tissues eg meat, egg, milk etc. The consequence of that is sub therapeutic doses of such antibiotics in humans facilitates development of resistance especially that classes of antibiotics use in both humans and animals.

Many developing countries don't have acceptable levels for such antibiotics and very poor surveillance of antibiotics in edible tissues compound this problem as such governments have to act fast to curtail the rapid development of resistance.

That's right, indiscriminate use of antibiotics in food animals and agriculture is one of the major contributors in emergence of antibiotic resistance among microbes. Again to address this issue, there should be well coordinated extensive programmes to create awareness among public and also effective regulation on part of the governments to regularise and monitor such usage of antibiotics by the public.

well, its a good question that we( Medical person) all are very much aware of it and misuses of Antibiotics are very common specially in the developing world. The main reason is you can buy the medicines without doctor's prescription. And most of the people see from the temporary point of view like if an individual is having fever , go and get medicine from pharmacy just like you do get the things from grocery shop and take it, they dont care about the reasons, side effects, when to take and when not to take etc so in my opinion people should be aware of these things and Government should implement the right action against this kind of tradition and most importantly should make a law regarding this pivotal health issue.

Thank You everyone. We all need to work together. Let us do our job and hope others will do theirs. All the best.

Very important and crucial questions with long lasting impact on health of peoples especially in poor countries where medical profession is highly profitable owing to poverty and meager spending in health sector. A lot has been discussed in earlier posts. I think in developing countries we can avoid injudicial use of antibiotic by restricting the physicians from taking gifts from the medical companies.

First thing we should do is practice strict standard operating procedure when performing antimicrobial susceptibility testing

secondly record all the data and regularly meet with clinicians on what action to take/what drugs are better for emphirical therapy

to start with

Please visit the website absn.in, we are doing a lot of research and advocacy on this topic in India

Antibiotic resistance is a challenge and menace already as most experts who work regulary in ICU would agree.

A case in point -

24-year-old doctor at Mumbai hospital dies of MDR-TB

http://articles.timesofindia.indiatimes.com/2013-07-01/mumbai/40306413_1_sion-hospital-resident-doctors-maharashtra-association

And this is just one ... there are so many more ... reported and unreported!

In regard to antibiotic resistance menace:-

New National Anitbiotics Policy on anvil *(Courtesy: the Hindu)

http://www.thehindu.com/sci-tech/health/policy-and-issues/new-national-anitbiotics-policy-on-anvil/article4958425.ece

http://www.chennaideclaration.org/ Another forum of specialists who have pledged to bring to end the menace of antibiotic resistance due to irrational prescriptions.

Dear Akilesh,

Such works (New National Antibiotics Policy) are necessary, especially in the developing world.

Thank You.

Dear Ashish,

I visited the website. It was very good to see works being done.

Best regards.

Tracking the sensitivity patterns of bacteria including Enterococcus spp and Staphylococcus spp and enterobacteriaceae will certainly be the first step as these are the bacterial species that often are responsible for different infection types (community acquired/Nosocomial infection)

Another important aspect is the resistance transferability: the need to addressed to curb emerging resistance towards newer antimicrobials and resistant bacteria previously sensitive

An antibiotic is one which saves the lives of the sick.

these are misused not by doctors but by patients themselves.

Prescribing an antibiotic must be made more transparent and accountable.

In a country like India, this would be difficult.

Rationale of prescription of an antibiotic may be made more easier if the organism is isolated and sensitivity understood.

Not only this in some instances Antibiotics are prescribed along with steroidal drugs to get more reliability on doctors as the recovery time is very fast. it is very alarming and unfortunate that Cepha drugs are being used in anti viral and anti microbial treatment.Also Drug Resistance will be a big threat and challange in forth coming days.Doctors should precautiously and relevently prescribe Antibiotics...otherwise mass number of people will be victim to Drug Resistat shortly...

Dear Tapan and Saiful,

I totally agree.

Thank You.

Dear Fakhrul,

It is really informative.

Antibiotics guidelines 1996. Is that the latest we have ?? Just wondering if we have anything new updates !!!

Thank You.

Look for BMJ 2012;344:e3369 and also use all your skills and energy to fight ignorance!

We become very complacent but if you do not act at right time you end up facing a greater problem

I have quoted the above keeping in mind the significance of regular evaluation of antimicrobial susceptibility patterns of a hospital/clinic/area/ and regulary change prescription patterns to avoid the menace of multi drug resistance (MDR)

Thank You.

Please also visit absn.in to look for efforts made by RD Gardi Medical College, Ujjain, MP, India, KI, Sweden and SIDA

I think that sometimes, without antibiotics can not do. But even if they are used, the physician should have extensive knowledge in the field of homeopathy, alopatii and orthomolecular medicine.

Medical practitioners role has to be really emphasized in this particular aspect as they usually are the one who can decide, is it really necessary to put a person on antibiotic, if put what re the advantages and if not what are the factors that need to be taken in to consideration.

Duration of antibiotic therapy, specific doses are other important factors in antimicrobial drug resistance