Need To Promote Antibiotic Stewardship


Antibiotics are one of the most prized discoveries in the history of medicine. They have saved countless lives and have been instrumental in the treatment of bacterial infections. However, the overuse and misuse of antibiotics have caused a significant threat to public health with the emergence of antibiotic-resistant bacteria. Nepal along with the world just celebrated this year’s World Antibiotics Awareness Week from 18-24 November with the theme “Preventing Antimicrobial Resistance Together”.

In recent years, the world has been grappling with an invisible enemy that poses a significant threat to global health security – the epidemics of antimicrobial resistance (AMR). AMR refers to the ability of microorganisms, such as bacteria, viruses, and parasites, to withstand the effects of drugs that were once effective in treating them. This growing phenomenon has far-reaching consequences, and it is high time we address it as a global priority.

Misuse of antibiotics

AMR has been quietly spreading across the globe, fueled by a combination of factors such as overuse and misuse of antibiotics, inadequate infection prevention and control measures, and the lack of development of new antimicrobial drugs. The consequences of this rise are dire, as common infections that were once easily treatable are becoming increasingly difficult to manage. The World Health Organisation (WHO) estimates that by 2050, AMR could cause 10 million deaths annually, surpassing cancer as a leading cause of mortality.

Beyond the human toll, AMR also poses a significant economic burden. The cost of treating drug-resistant infections is exorbitant, requiring longer hospital stays, expensive drugs, and more complex treatment regimens. Additionally, the impact on productivity due to prolonged illness and increased healthcare costs places an immense strain on healthcare systems and national economies. If left unchecked, AMR could cost the global economy up to $100 trillion by 2050.

AMR threatens to unravel the advancements made in modern medicine. Procedures such as organ transplants, chemotherapy, and complex surgeries heavily rely on effective antibiotics to prevent and treat infections. However, as AMR continues to spread, these life-saving interventions become riskier, potentially leading to a resurgence of untreatable infections. The post-antibiotic era, where even minor infections could become life-threatening, is no longer a distant possibility but a looming reality. Strengthening surveillance systems to monitor AMR patterns, promoting responsible use of antibiotics, investing in research and development of new antimicrobial drugs, and improving infection prevention and control measures are crucial steps toward mitigating the impact of AMR.

In the above situation, antibiotic stewardship is a crucial strategy to address this issue and ensure the responsible use of antibiotics. Antibiotic stewardship refers to a set of coordinated strategies to improve the use of antibiotics. It involves the appropriate selection, dosing, and duration of antibiotics, as well as the prevention and control of infections. Antibiotic stewardship programs aim to optimise patient outcomes, reduce the risk of adverse events, and minimize the development of antibiotic resistance.

The need for antibiotic stewardship is urgent. The misuse of antibiotics is a significant contributor to this problem. Antibiotics are often prescribed unnecessarily, such as for viral infections, which do not respond to antibiotics. In addition, antibiotics are frequently prescribed at incorrect doses or for longer than necessary, which can contribute to the development of antibiotic resistance. Antibiotic stewardship programmes can help address these issues. These programmes involve a multidisciplinary team of healthcare professionals, including physicians, pharmacists, and infection control professionals. The team works together to develop and implement guidelines for the appropriate use of antibiotics. These guidelines are based on the latest evidence and take into account local patterns of antibiotic resistance.

One of the key components of antibiotic stewardship is the use of diagnostic tests to identify the cause of infections. This allows healthcare professionals to determine whether antibiotics are necessary and, if so, which antibiotics are most effective. Rapid diagnostic tests, such as polymerase chain reaction (PCR) tests, can provide results within hours, allowing for timely treatment decisions. Another important aspect of antibiotic stewardship is the use of antimicrobial stewardship software. This software can help healthcare professionals track antibiotic use and resistance patterns, identify areas for improvement, and monitor the effectiveness of interventions.

This information can be used to develop targeted interventions to improve antibiotic use and reduce the risk of antibiotic resistance. Education and training are also essential components of antibiotic stewardship. Healthcare professionals need to be aware of the risks associated with antibiotic overuse and misuse and understand the principles of responsible antibiotic use. Patients also need to be educated about the appropriate use of antibiotics and the risks associated with antibiotic resistance.

Effectiveness

Antibiotic stewardship programmes have been shown to be effective in reducing antibiotic use and improving patient outcomes. A study conducted in a large academic medical centre found that the implementation of an antibiotic stewardship programme led to a 36 per cent reduction in antibiotic use and a 30 per cent reduction in the incidence of Clostridium difficile infections. Another study conducted in a community hospital found that the implementation of an antibiotic stewardship program led to a 27 per cent reduction in antibiotic use and a 33 per cent reduction in the incidence of antibiotic-resistant infections.

In conclusion, antibiotic stewardship is a crucial strategy to address the growing problem of antibiotic resistance. Antibiotic stewardship programmes involve a multidisciplinary team of healthcare professionals working together to develop and implement guidelines for the appropriate use of antibiotics. These programmes can help reduce antibiotic use, improve patient outcomes, and minimise the development of antibiotic resistance. Antibiotic stewardship is a critical public health issue, and it is essential that healthcare professionals and patients work together to ensure the responsible use of antibiotics. Failure to act swiftly will leave us defenceless against the growing tide of drug-resistant infections, with devastating consequences for humanity.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)TRN Online