Antibiotics are drugs used for the treatment of bacterial infections and have no action on viruses, fungi, or parasites.This article discusses the Indian scenario of antibiotic resistance and misuse along with its impact on mankind.

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Antibiotics and antimicrobials

Antibiotics and antimicrobials are drugs used to treat infections caused by bacteria, viruses, fungi, and parasites. However, there are some key differences between the two medications.

Antibiotics- They specifically target bacteria and are used to treat bacterial infections. They do not work against viruses, parasites, or fungi. Examples include penicillin, tetracycline, and ciprofloxacin.

Antimicrobials- A broader term that includes antibiotics and other drugs used to treat infections which include drugs that fight viruses, fungi, and parasites in addition to bacteria.

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Antibiotic misuse

Inappropriate use of antibiotics leads to antibiotic-resistant bacteria and reduces the effectiveness of antibiotics. Examples of antibiotic misuse include;

1. Taking leftover antibiotics from a previous illness.
2. Requesting antibiotics from a healthcare provider for a viral illness.
3. Failure to complete a full course of antibiotics.
4. Using antibiotics as a preventive measure.

What is antibiotic resistance?

Ability of bacteria to counteract the effects of antibiotics & makes the treatment challenging or impossible. Causes of antibiotic resistance include;

• Overuse and misuse of antibiotics
• Poor infection control practices
• Lack of development of new antibiotics
• Spread of resistant bacteria between people and through the environment.

Antibiotic resistance is a major public health problem because it can lead to;

1. Prolonged illness and suffering.
2. Spread of treatment-resistant infections.
3. Increased risk of death, especially in vulnerable populations such as the elderly and people with weakened immune systems.
4. Increased healthcare costs due to the need for more intensive or prolonged treatment.
5. Antibiotic resistance also threatens many medical advances such as organ transplantation, cancer chemotherapy, and surgery that rely on antibiotics to prevent and treat infections.

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Current prevalence of antibiotic resistance in India

Antibiotic resistance is a global public health problem that affects all countries and regions. According to the World Health Organisation (WHO), antibiotic resistance is on the rise, making it difficult to treat common infections and threatening the effectiveness of modern medicine.

Excessive and inappropriate use of antibiotics has led to the developing resistance to bacterial pathogens. Combined with inadequate infection control, this leads to the development and spread of antibiotic-resistant bacteria. According to a study by the Indian Council of Medical Research, about 60% of bacterial infections in India are resistant to first-line antibiotics, and the trend is increasing. One study estimates that the overall prevalence of antibiotic resistance in India is around 50-60% for major bacterial pathogens such as Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus.

The most problematic forms of antibiotic-resistant bacteria include;

• Methicillin-resistant Staphylococcus aureus (MRSA)
• Multidrug-resistant Acinetobacter
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Vancomycin-resistant enterococci (VRE)
• Extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae
• Carbapenem-resistant Klebsiella pneumoniae

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Causes of antibiotic resistance in India

The high prevalence of antibiotic resistance in India is due to various factors;

1. The misuse of antibiotics by physicians is a major factor in the growing problem of antibiotic resistance. Improper use of antibiotics leads to antibiotic-resistant bacteria, making it more difficult to treat infections.
2. Improper usage can occur for a variety of reasons, including patient pressure, a lack of access to diagnostic tools, or being unaware of their proper application. This can lead to the overuse of antibiotics, which can promote the development of resistance.
3. Access to healthcare is limited in developing countries, leading patients to self-medicate with antibiotics or seek treatment from non-medical providers.
4. Improper regulations and enforcement measures for the appropriate use of antibiotics can lead to overuse and misuse.
5. Inadequate education and awareness about the use of antibiotics and the dangers of antibiotic resistance.
6. Availability of the drug in hospitals (government/institutional supply)
7. The widespread use of antibiotics in agriculture, especially in animal feed, contributes to antibiotic resistance.

Other causes of antibiotic resistance that require attention include;

1. Clinical pharmacists and antibiotic misuse: Pharmacists also contribute to the growing problem of antibiotic resistance. Improper dispensing of antibiotics without a prescription and giving the wrong advice about dose and duration can lead to antibiotic resistance.
2. Alternative practitioners and antibiotic misuse: Alternative medicine practitioners also contribute to antibiotic resistance. They often prescribe antibiotics inappropriately or without proper diagnosis, which can lead to improper antibiotics.
3. Antibiotics and Critical Care: Antibiotics play a critical role in the treatment of infections in critical care settings, such as the intensive care unit (ICU). The misuse of antibiotics in critical care is a growing concern due to the potential for antibiotic-resistant infections to develop. The overuse or misuse of antibiotics in the ICU may be due to factors such as pressure to treat infections quickly, lack of rapid diagnostic tests, and lack of knowledge about appropriate antibiotic use
4. Antibiotic misuse by laypersons: This refers to taking antibiotics without a proper diagnosis or prescription from a healthcare provider. This can include self-medicating with leftover antibiotics, taking antibiotics prescribed to someone else, or taking antibiotics for viral infections that are not effective against viruses. This can contribute to the problem of antibiotic resistance.

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How to combat increasing antibiotic resistance

Antibiotic resistance is a complex problem that requires a coordinated response from multiple sectors, including health-care providers, patients, public health agencies, agriculture, and the environment. To address the problem of antibiotic resistance, it is necessary to implement programs for the responsible use of antibiotics, increase education and awareness about the appropriate use of antibiotics, enforce regulations and guidelines for the use of antibiotics, improve infection control practices, stop the over-the-counter sale of antibiotics, and enforce the law against the prescription of antibiotics by non-physicians, etc. In addition, it is important to promote the development of new antibiotics and improve infection control in healthcare.

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Antibiotic stewardship

Antibiotic stewardship is a coordinated program that promotes the appropriate use of antibiotics to improve patient outcomes, reduce antibiotic resistance, and limit the spread of infections. This includes strategies such as;

1. Selecting the right antibiotic for the right patient.
2. Determining the appropriate duration of therapy.
3. Preventing infections through infection control measures.
4. Monitoring and tracking antibiotic use and resistance patterns.

The problem of antibiotic resistance requires a multidisciplinary and coordinated global response to reduce its impact and preserve the effectiveness of antibiotics. 

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Naman Jain is a practising rheumatologist from Chattisgarh.