Antibiotics Use and Misuse: A Monograph

The Indian College of Physicians, the academic wing of the Association of Physicians of India has brought out a monograph on ‘Antibiotics Use and Misuse’ edited by Dr. Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Dr. Subhash Todi (drsubhashtodi@gmail.com). It has been divided into 3 sections. In the first section, discussion is about the rationale and appropriate use of antibiotics including suggested antibiotics for various infections with dosing followed by their use in outpatient departments, indoors, intensive care, immunecompromised states and peri-operative area. The second section discusses their misuse particularly over the counter use and use in veterinary, differences in urban and non urban consumption and how the antibiotics are being used in developing countries including India. The last section gives perspective of microbiologists towards antibiotic resistance, issues related to regulations and how audits can improve the prescription behaviour, compliance to regulations and lastly the Chennai Declaration – an initiative of professional medical bodies, which provides a road map to reduce the incidence of resistance and introducing the culture of discipline in antibiotic use and prescription in the country. The monograph is authored by a mix of physicians, intensivists, microbiologists, administrators, clinical pharmacologist and veterinary public health professionals, well known in their respective areas to have a 360 degree view on the issue. The contents of the monograph are as under:

Section 1 – Rational Antibiotic Use

• Chapter 1: Guidelines for Antibiotic Use in India by George M. Varghese (georgemvarghese@hotmail.com) and Paul Trowbridge (ptrowb@hotmail.com)
• Chapter 2: Use and Abuse of Antibiotics in Outdoor (OPD) Patients by Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Mukesh Sharma (drmks80@gmail.com)
• Chapter 3: Antibiotic Use and Abuse in Inpatients (Medical and Surgical) by Dhruva Chaudhry (dhruvachaudhry@yahoo.com) and Sunny Virdi (drsunnyvirdi@gmail.com)
• Chapter 4: Use and Misuse of Antibiotics in the Intensive Care Unit by Subhash Todi (drsubhashtodi@gmail.com)
• Chapter 5: Antibiotics in Peri-operative Care by J. V. Divatia (jdivatia@yahoo.com) and Amol Kothekar 
• Chapter 6: Antibiotics in an Immunocompromised Setting by Gaurav Prakash and Subhash Varma (suvarma@hotmail.com)

Section 2 – Misuse of Antibiotics

• Chapter 7: Over the Counter Use of Antibiotics by Subhash Todi (drsubhashtodi@gmail.com) 
• Chapter 8: Use of Antimicrobials in Veterinary and Animal Husbandry Practices by Sudhi Ranjan Garg (srgarg415@gmail.com)
• Chapter 9: Urban and Non-urban Consumption of Antibiotics by M. C. Gupta (dr.mcgupta57@gmail.com) and Niti Mittal (drniti.mittal@gmail.com)
• Chapter 10: Antibiotic Use in Developing Countries by Dhruva Chaudhry (dhruvachaudhry@yahoo.co.in) and Rahul Roshan (rahul.roshan81@gmail.com) 

Section 3 – Way Forward

• Chapter 11: Regulatory Issues in Antibiotics by B. L. Sherwal (drblsa703@yahoo.co.in) and Sonal Saxena
• Chapter 12: Microbiologist Perspectives on Antimicrobial Resistance by Raman Sardana (ramansardana@apollohospitals.com)
• Chapter 13: Prescription Behaviour and Audit of Antibiotics by M. C. Gupta (dr.mcgupta57@gmail.com) and Savita Verma
• Chapter 14: Antibiotic Stewardship by Neetu Jain (neetusms@yahoo.com) and Gopi C. Khilnani (gckhil@gmail.com)
• Chapter 15: Chennai Declaration by Abdul Ghafur (drghafur@hotmail.com) 

World Health Assembly addresses antimicrobial resistance

The World Health Assembly recently made resolutions to tackle antimicrobial resistance. Delegates endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug resistance trend. Antimicrobial resistance is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine.

The plan sets out 5 objectives:

1. Improve awareness and understanding of antimicrobial resistance.
2. Strengthen surveillance and research.
3. Reduce the incidence of infection.
4. Optimize the use of antimicrobial medicines.
5. Ensure sustainable investment in countering antimicrobial resistance.

The resolution urges Member States to put the plan into action, adapting it to their national priorities and specific contexts and mobilizing additional resources for its implementation. Through adoption of the global plan, governments all committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. It needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans, and will report progress to the Health Assembly in 2017.

Source: WHO