Despite six decades of antimicrobial drug use bacterial infections are significant causes of human morbidity and mortality. Antibiotics in large number have become the favourite of both prescriber and consumer. More than 30% of all hospitalized patients receive one or more courses of antibiotics. Even though the use of antibiotics in the treatment of human disease is essential and unavoidable; it is widely acknowledged that there is unnecessary, uncontrolled or suboptimal use of these antibiotics.
In present day prescribing practice, new and costly drugs are preferred without appropriate bacteriological study probably due to pressure from pharmaceutical firms. A reappraisal of the existing prescribing practice in our country shows that antimicrobials are over prescribed by medical practitioners without specific indication, used for diseases where they are not effective, used in appropriate dose, duration and combination.
Antibiotics are given to human for treatment and prophylaxis of infectious diseases, 80% to 90% of antibiotics are used in outpatients and the remainder in hospitals. Antibiotics are appearing to be used not only in excess but also inappropriately and this account for 20%to 50 % of all antibiotics used.4-5 The Centre for Disease Control and Prevention in USA has estimated that some50 millions of the 150 million prescriptions every year are unnecceary.
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Around 70 % of the bacteria that are responsible for causing infections in hospitals are resistant to at least one of the antibiotic agents that are commonly used for treatment. There are organisms resistant to all approved antibiotics and can be treated only with experimental and potentially toxic drugs. The sudden increase in bacterial resistance that cause community acquired infections has also been recorded, especially the Staphylococci and Pneumococcal (Streptococcus pneumonia), which are important in causing the disease and mortality. From the recent study results it is evident that 25% of bacterial pneumonia cases were seen to be resistant to Penicillin, and an additional 25% of cases were found to be resistant to more than one antibiotic.
Antibiotic usage resistance rates vary from one country to another. It is observed that countries with the highest per capita antibiotic consumption have the highest resistance rates. It is not only the amount of antibiotic used that select for resistance, but the number of individuals receiving the drug and the population density also matters. Giving 1000 doses of an antibiotic to one individual will have considerably less ecological effect on resistance emergence than giving those same 1000 doses to 1000 individuals. A study by Levy suggests that combination of antibiotic use and population density correlates more strongly with the prevalence of antibiotic resistance in a population than use of the antibiotic alone.12
Unless antibiotic problems are detected, as a emerge and actions are taken to contain them, the world would be faced with resistant bacterial strains with no known or new antibiotics left are available to combat them.11
For more than 50 years, pharmacists have dispensed antibiotics to treat infections caused by bacteria and other micro-organisms. They are most important weapons in our hands. Within general practice, infections are common presenting problems and antibiotics are among the most frequently prescribed drugs.
Inappropriate antibiotic-prescribing practices have been well described in developed nations, but data are lacking for developing countries. Overuse of antibiotics can result in high prevalence of resistance to commonly prescribed antibiotics, necessitating the use of more expensive second- or third lineagents.13
In general practice infections contribute around 40% of consultations. For every 1000 patients general practice submit 40-400 urine samples and laboratory results provides a change in antibiotic therapy up to 28% of cases. However, the information that is needed to document the influence of microbiology reports on antibiotic selection and prescribing is very little.14
Role of Pharmacist in reducing antibiotic resistance
A Pharmacist plays an important role in reducing antibiotic resistance by:
Counselling of individual patient on appropriate use of antibiotics, such as choice of drug, dose and duration.
Attending ward rounds and acting as a point of communication between pharmacy, microbiology and infectious disease and infection control teams.
Preparing evidence based local prescribing guidelines for antibiotics.
Promoting good prescribing practice.
Monitoring antibiotic use in terms of volume or â€˜defined daily doseâ€™ and expenditure.
Providing educational and training program in antibiotic therapy for Doctors, nurses, pharmacists and medical and pharmacy students.15
Always on Time
Marked to Standard
Compared to elsewhere in the world, misuse of antibiotics is rampant in India. This is mainly due to the ignorance about infection epidemiology. Incidence of resistance to common organisms, which is caused by irrational overuse of antibiotics, is highest in India
Developed Nations provide reliable statistics on antibiotic resistance and policies that are very much useful in controlling the of spread of resistant pathogens. However, such statistical data are not much distributed from India due to large scale, meta- analytic studies. The antibiotic prescription practices followed by the clinicians also has to be monitored. The prevalence of drug resistance is a unique pattern in almost all the developing countries. The increased risk in the spread of resistant strains both in the community and in healthcare areas of the developing countries are due to the poor environmental sanitation, nutritional deficiencies in the host and certain endemic infections.
The entire work was planned to be carried out for a period of 8 months from June 2010 to January 2011. The proposed study was designed in three different phases.
To conduct a Prospective study on the common organisms isolated during culture on sensitivity testing and the antibiotic sensitivity pattern of microorganisms towards antibiotics in the study hospital for a period of 8 months (from June 2010 to January 2011)
To collect relevant demographic information and information on duration of hospitalisation of patients with antibiotic prescription admitted to the general medicine ward and pulmonology ward for an 8 months period (from June 2010 to January 2011).
To analyse the pattern of antibiotic use and to document for any changes in the sensitivity pattern of microorganisms