After love for the game of cricket, what can be the next best love we have? It would be a narrow miss for any other response compared to the love for indiscriminate use of antibiotics. Instead of using against only proof of germs invading the body, the implicit cliché in vogue is, “if you are in doubt, use antibiotics”. Is this vindicated?
Antibiotics are substances that control the growth or kill micro-organisms. If used judiciously, these amazing drugs can benefit the infected person and can save lives. Otherwise, they are rendered useless and deleterious in the long run particularly when uninfected people use for the love of it. This is called as anti-microbial resistance. As an analogy, if you are used to lifting 10-pound dumbbells every day for weight training, the 5-pound weight is a cakewalk for you.
Similarly, after developing resistance, the primary lines of antibiotics can no longer destroy micro-organisms. According a report by Centre for Disease Control (CDC), nearly 50 per cent of antibiotics used are either not required or not efficient. To elucidate, out of 100 common infections causing fever, 50 people receive antibiotics when it is not needed (for example, viral infections, for which the antibiotics are useless) or get prescription of higher antibiotic ignoring the initial lines of drugs.
If any of these 50 people go on to develop serious infections later in their life, the specialists can no longer use that class, or even higher antibiotics, for treating them. As a result, the doctors will have limited options to treat, and have to choose more toxic, high-priced and less efficient drugs.
The survival probability in such patients is low and if they survive, the hospital stay is going to be longer, with higher chance of disability in the long run. For all the love, the indiscriminate use of antibiotics becomes the dominant origin of antibiotic resistance.
What is driving this injudicious use? As ironic as it sounds, it is the very intention of doing good (albeit misdirected). The underlying assumption stems from magical thinking that by nature, antibiotics are helpful under all circumstances. Educated parents yearn for antibiotics and ensure that they get prescription or shop for doctors till they get one.
The next benevolent person is a friendly pharmacist in the neighbourhood who can give any drug without prescription.
Next, doctors want better outcomes for their patients by prescribing higher antibiotics over first or second line. Antibiotics are also used to prevent, control, and treat disease in animals that we eat. Irrevocably, the regulatory framework assumes that everyone in this chain is carrying out action in good faith. Apart from misdirected altruism, there are non-formal healers who prescribe antibiotics without knowledge of either illness or drugs.
When down with fever, it is more of a predictable conjecture that doctors as well as patients are tempted to use antibiotics. At this point, little do they realise that inapt faith in antibiotics will do more harm than good? Instead of the misplaced love in antibiotics, we all can fight antibiotic resistance by taking simple steps. The least is to prevent the spread of infections by hand washing, making sure kids are completely immunised for their age and keeping kids out of school when they’re sick so that they don’t spread infections.
Doctors should not prescribe antibiotics until culture reports are available. For a germ-free nation, we need freedom from our obsessive mindsets of using antibiotics. The inventory of antibiotics manufactured in the country should be strictly monitored. Every antibiotic prescription should have the registration number of the doctor who prescribes it. In case of second line and beyond, the prescription should contain the first line tried and the indication for using the higher antibiotics.
Third, no pharmacy should give antibiotics without prescription. This can be ensured by entering the batch number and number of strips by pharmacy against each prescription for antibiotic.
The IT prowess of the country should be involved in developing apps that track the entire distribution network of antibiotic from the site of manufacturer to end users. Can policy makers set aside minimal investments in robust information systems? If yes, this can assure prompt provision of right drug at the right dose for right duration. By most of these mechanisms of misdirected good faith, we are in a huge muddle. But can this not change with each citizen contributing with his/her might?
(The writer is Additional Professor, Indian Institute of Public Health, Bengaluru)