Nearly 1 in 4 adults would use antibiotics without prescriptions: US Study

Contributed by Siddarth David & Dr. Tamhankar

A study published in the journal Antimicrobial Agents and Chemotherapy found that nearly 5% of the 400 people surveyed had used antibiotics without prescription and nearly one-fourth would intend use antibiotics without a prescription. The study conducted in Texas showed that  one in twenty used these antibiotics to treat self-diagnosed viral illnesses like the flu and colds, even though antibiotics don’t work on viruses and one in four said they would use any antibiotic they had in the house to treat a sore throat, cough and runny nose.

The lead author of the study Larissa Grigoryan said that when people self-diagnose and self-prescribe antibiotics it is likely that the therapy is unnecessary because most often these are upper respiratory infections that are mostly caused by viruses. She also pointed out that the most common conditions patients reported self-treating with antibiotics were sore throat, runny nose or cough which were conditions that typically would get better without any antibiotic treatment. The study also showed that about one in twelve respondents had leftover antibiotics available at home which could be used, another critical cause for concern.

The study has shown yet gain that self-prescription of antibiotics was a critical contributor in the process of antibiotic resistance. Awareness and strict monitoring of purchases would be crucial to address the problem and should be part of the local, national and global policies to address antibiotic resistance.

"Superbug" strains discovered across the world

Contributed by Siddarth David & Dr. Tamhankar

The multi-drug resistant strain of E. Coli with the MCR-1 gene has been isolated in New York, in the United States last week, making it second case the US. In April an isolate with MCR-1 gene was identified in a patient in Pennsylvania who had urinary tract infection. The new case was identified by the SENTRY Antimicrobial Surveillance Program, of JMI Laboratories based in the US, that has been analysing samples from US hospitals and those across the world since 1997. Out of the nearly 20,000 samples tested the lab found almost 2% (390) samples showed the presence of theMCR-1 gene including from Germany, Italy, Spain, Malaysia, Honk Kong, Brazil and Russia. These were associated with bloodstream infections, skin infections and urinary tract infections.

The discovery of the colistin, a last-line antibiotic, resistant gene in samples from meat as well as hospital in China last year had led to alarm bells ringing panic across the world on the extent and spread of the resistance. Moreover most of the cases the gene was carried on the plasmid DNA of the bacteria which would make it easy for it to be transferred between bacteria, facilitating its easy and rapid spread which could become a global public health crisis. After the discovery of the case in the US, The Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health are working on trying to trace the origin of the bacteria to prevent any possible spread as well as understand its environment to ascertain if there could be more cases.

This, is another call for the adoption and implementation of stricter and more rational antibiotic use across the world in order to avoid more chances of the development of such multi-drug resistant "superbugs".  

Shorter courses of antibiotics as good as longer courses in post-surgical infections

Contributed by Siddarth David & Dr. Tamhankar

Research paper from the University of Miami have indicated that having shorter course of antibiotic treatment is as effective as long courses in reducing post-surgical infections . The paper based on randomized controlled trial of patients with complicated intra-abdominal infection (CIAI) found that four days of antibiotic therapy worked as well as the seven currently recommended in medical practice.

Published in the New England Journal of Medicine, the research said there was no difference between those in the short-course and those in the long-course arm in incidence of surgical site infection, recurrent intra-abdominal infection, CDI [Clostridium difficile infection] or any other extra-abdominal infection . It also says that the findings hold true even for those at higher risk for infection making it an important consideration in an era investigating ways to curtail overuse of antibiotics at hospitals.

The findings though are of single study and is more of a hypothesis-generating nature, it still underscores the fact that antibiotic stewardship is an important part of a broad strategy to reduce the risk of antimicrobial resistance. The findings of the study contributes to the growing body of literature on infection risk factors and antibiotic resistance.

Implementing Antibiotic Stewardship in Hospitals can significantly reduce Consumption and Infections

Contributed by Siddarth David & Dr. Tamhankar

A meta-analysis study published by Brown University, US researchers have indicated that if a hospital adopts an antibiotic stewardship program its infection levels would drop considerably. The study published in the journal of the American Society for Microbiology last week, showed that such programs reduce use of antibiotics by more 20% in overall with maximum reduction in the Intensive Care Units (ICUs) of nearly 40% which is a key site for infections.

Use of restricted antibiotics fell by more than one-fourth after an a stewardship program, and use of broad-spectrum antibiotics declined by nearly one-fifth the study showed. The study also quelled fears that restricted use of one drug would increase dramatically the consumption of others. The study showed overall infections were reduced by 5% across hospitals that have started antibiotic stewardship programs and reduced length of hospital stay by around 9%. The expenditures incurred to hospitals in buying antibiotics also fell sharply.

The study reaffirms the fact that adopting an antibiotic stewardship program has multi-faceted benefits to the hospital: drug expenditures, infection rates, and length of hospitalization and most importantly use of antibiotics. This should serve a tool to dispel popular myths that following antibiotic stewardship program would affect the hospital's service quality and patient outcomes as well as finances. It should be part of health policy to enforce such stewardship programs in all health facilities to tackle the issue of antibiotic resistance.

SOP for tackling antibiotics at hospital-level to be ready in India soon

Contributed by Siddarth D & Dr. Tamhankar

Microbiologists from six major hospitals of the country are scheduled to meet in New Delhi and finalise the draft of the standard operating procedures (SOPs) to be used by hospitals to address antibiotic resistance. These six facilities  PGI in Chandigarh, JIPMER in Pondicherry, AIIMS in Delhi, CMC in Vellore, PD Hinduja in Mumbai, and Assam Medical College in Dibrugarh would develop the draft which would then be implemented in other health-facilities in the country.

The SOP will include antibiotic stewardship, methodology regarding defining a case or recording a case will, an infection control manual and steps to calculate infection rates. It would outline a systematic defining and managing  infection rates through a central software, pool the data making a national registry. The project is executed by AIIMS, Centres for Disease Control (USA) and Indian Council for Medical Research (ICMR). ICMR has already made four of the facilities: PGI in Chandigarh, JIPMER in Pondicherry, AIIMS in Delhi, CMC in Vellore as nodal centres for tracking drug resistances a few years back.

This is a great step forward in India as the country yet to have a set of SOPs for health-facilities that are contextual and implementable. The involvement of public and health private hospitals in developing the guidelines would increase its acceptability in India's fragmented healthcare system.

By 2050 antibiotic resistance could claim more lives than Cancer: IMF Panel

Contributed by Siddarth D & Dr. Tamhankar

 

Last week at the IMF meeting in Washington, UK Chancellor George Osborne stated that 10 million people a year could die across the world by 2050. This was more than the number of people dying due to cancer each year. The Chancellor also warned of the economic cost of resistance which could cut global GDP by 3.5%, a cumulative cost of $100bn (£70bn). Thus, unless global action is taken, antimicrobial resistance will become an even greater threat than cancer currently is.

The panel which is part of the IMF's Annual Spring Meeting is being held in Washington DC and is looking at emerging economic concerns that could arise in the future. WHO representatives would also be attending the meeting to put forward health concerns that could result in economic challenges.

While there is recognition of the health impact of antibiotic resistance, the human costs and economic costs are seldom discussed. Given that pharmaceutical companies, drug manufacturers and the markets play a critical role in shaping healthcare outcomes and policies for antibiotic use, it is critical that bodies like the IMF are aware and act on health concerns due to antibiotic resistance. Without policies and incentives to regulate the drug market, the battle against antibiotic resistance would certainly be impossible to win.  

Awareness and incentives reduce prescribing of antibiotics in UK

Contributed by Siddarth D & Dr. Tamhankar 

 

Over 2 million fewer antibiotic prescriptions were dispensed in primary care throughout 2015 compared to the year before, according to data from NHS (National Health Service) in the UK. This was 7.9% reduction was attributed the incentives introduced to general physicians as well as extensive campaigns to build awareness on antibiotic resistance. 

The NHS along with the Public Health England Department had initiated these campaigns with emphasis in hospitals on vaccinations, general hygiene practices and judicious prescribing of antibiotics. Healthcare facilities and healthcare providers  following these recommendations and demonstrating fall in antibiotic prescribing and consumption were given financial incentives through the campaigns. Given that safely reducing the amount of antibiotics prescribed to patients was an important part of work to tackle antimicrobial resistance, the  NHS and the PHE had started series of campaigns to reduce prescription of antibiotics. It was based on the fact that inappropriate use and overuse of antibiotics were known drivers of resistance, so reducing the amount of antibiotics consumed slowed bacteria developing resistance to these vital drugs and therefore helped prevent antibiotic-resistant infections. 

The NHS officials have lauded these results and promised to do more to tackle the menace of antibiotic resistance. This a good impetus for other countries to follow, by taking up initiatives involving the healthcare system itself to achieve substantial results in curbing antibiotic resistance.