There is an urgent need to take initiatives to formulate an effective national policy to control the rising trend of antimicrobial resistance in India, including a ban on over-the-counter sale of antibiotics, and changes in the medical education curriculum to include training on antibiotic usage and infection control. I would be very much interested to know how the developed countries are handling such a situation and make proactive measures in preventing antimicrobial resistance. Your opinions and suggestions are highly appreciated.
Dear Srikanth
The 2001 WHO global strategy for the containment of AMR addresses what to do and how to do it and provides a framework of interventions to slow the emergence and reduce the spread of antimicrobial resistant microorganisms wherever anti-infective
medicines are used, through:
• reducing the disease burden and spread of
infection;
• improving access to appropriate antimicrobials;
• improving the use of antimicrobials;
• strengthening health systems and their
surveillance capabilities;
• enforcing regulation and legislation;
• encouraging the development of appropriate
new drugs and vaccines.
http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf
With best regards
This a very important Issue. Time by Time we are setting new guide lines and protocol to control the prevalence of MDR. However, the basic thing is education in Pakistan and India this looks to be possibly impossible. Most of The Pak-India Population is un-educated and they do not have any interest in controlling antibiotic resistance but un-educated population just want quick response with less expenses. therefore, Pak-India should set guide lines and goals to educate population.
I agree on the importance of atimicrobial resistance especially in south asia. Apert from education the need is to create antibiotic sub-committees within hospitals and these committees should have the authority to question usage of antibiotics, should maintain antibiotic usage data in laision with pharmacy and should have the decisive power for use of certain antibiotic groups like linezolid/ polymyxin etc. we have tried doing this in our hospital and it works. secondly lab data on antibiotic resistance should be shared with physicians to highlight the trends of increasing antibiotic resistance and reinforce the eed for appropriate antimicrobial use.
further, infection cotrol surveillance and timely isolation of subjects with MDR organisms goes without saying
starting from the Institutional level. we should have an institutional antibiogram. Compare it with local, district, state and national levels. there should be a central authority
I think in India antibiotic prescription in most of the cases is to satisfy the patient, to earn money, rather than patient perspective. I such cases we should sell placebo antibiotics and should see the difference
I suggest to control using of appropriate antibacterials in food, environment, diseases covering etc. It should be special program at local and national levels.
Monitoring the prevalent resistance patterns and regularly modifying prescription practices will do a lot of benefit
We should carefully record all the data
1) the type of sample
2) the patient diagnosis
3) department/unit/ward
4) provisional treatment
5) MOST IMPORTANT: Organism isolated: ANTIBIOGRAM
6) Prognosis of treatment/If Antibiotic change needed incorporate
7) Making sure the course of antibiotic is sufficient to eliminate/ prescribe for days required only
8) Avoid unnecessary antibiotic prophylaxis
9) encourage family physicians: so that patients are closely monitored
10) Abandon on the table sales of Antibiotics:
In the UK, the Department of Health and Chief Medical Officer released a 5 year strategy on beginning to deal with the AMR problem. See https://www.gov.uk/government/publications/uk-5-year-antimicrobial-resistance-strategy-2013-to-2018. Focuses on things like smarter prescribing habits, reducing antibiotic use in animals, and stimulating development of new antibiotics, as well as other preventive measures.
In the US, the CDC released a threat report on AMR (which is unprecedented) http://www.cdc.gov/drugresistance/threat-report-2013/
And if you're very bored, see my publications list for a couple of papers discussing investments in AMR research
https://www.researchgate.net/profile/Michael_Head2/contributions/?ev=prf_act
I would say that we should take measures to control the menace of multi-drug resistance, firstly use antimicrobials very judiciously
I believe that the need to control this should come from within and not from without. We definitely need to educate youngsters and show them proof that this is a menace and we need to address now.
In mexico, restriction policies have been implemented to reduce the consuption of antibiotics in the population, and now they're sold by prescription. Apparently this measure has achieved a decrease in the overuse of antibiotics. You might find interesting the next link: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0075550#pone-0075550-g003
In the other hand, in hospitals, it is a common practice to restrict broad-spectrum antibiotics to specialists, whom have to justify its use.
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