Curb unnecessary use of antibiotics and save humanity .

Contirubuted by 

Dr. Zahid Majeed Nadaf 

MD.DM(Crtical care Medicine ) AIIMS ,New Delhi 

Every pill or ampoule of antibiotic used for a human diminishes its utility for mankind forever is a brilliant quote from Mandel .

” fever is not lack of meropenem…. is yet another quote highlighting inadvertent use of antibiotics.  Thus it is a big responsibility on all of us for ensuring rational use of antibiotics

Indiscriminate  use of antibiotics has stepped  up and now there is widespread resistance and a time may come we will be left with no options in treating infection . We need to act

1.Planners need to think . Some laws like narcotics act  should be brought for community level usage while better training and evidence based hospital antibiotic policies should be enacted for hospitals…

2.If not needed for rightful indication aren’t neutral rather  are surely harmful eg if it is non biliary pancreatitis antibiotics are harmful rather than neutral, although clinically patient may have tachy ,inc tlc, fever and what not ..

3. Hospitals lack antibiotic audits and stewardship …Infectious diseases still isn’t a known and sought-after branch ….we have a long, long  way to go still …

4.Antibiotics are least known about  and most used by doctors …..

5.From  dosage , adjustment for organ dysfunction … we guess most of the time rather than resorting to good sources…..(like sanford antibiotic app, AIIMS antibiotic app, uptodate and medscape )….

6. People feel confident and skilled when using higher antibiotics, I have seen elective surgical cases being put on combos like piptaz …mero and levo …

7.Although there is no need to add metronidazole if the patient is on mero piptaz and magnex still it is added  .

8..Every staph is not MRSA …if empirical cultures are showing MRSA in more than 10 to 20 percent isolates then only Vanco can be added empirically….A staph that is not MRSA will respond  better to penicillins and Cephalosporins rather than vanco…..

9.We choose higher antibiotics based on parameters like tlc count,  fever rather than risk factors for Multidrug resistant organisms ..

10. On lower antibiotics patience isn’t shown and without waiting for 2 to 3 days …it is upgraded quickly .

11. Illnesses that seem sepsis and when without shock..before ruling out other causes there is rush to give antibiotics while we can wait for 3 hours to rule out other non infective causes..

12 For most of the cases 5 to 7 days therapy is non inferior to 14 days therapy…

13.Another way not backed by evidence is to treat it for like 2 weeks IV  then rather than sudden de escalation …shifted on oral antibiotics for another 10 days …stopping antibiotic as part of de-escalation and starting replacement with lower one rather than a stoppage …

Please whatever antibiotic we prescribe think and read about it once from some good source ,just once even  

Village level pharmacists give antibiotics that usually warrant ICU admission for trivial things …they are available OTC…..it is moral and ethical responsibility to use them rationally .

Antimicrobial resistance (AMR) is an equal  menace  like cancer and covid …and we play part in creating and  worsening it.

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