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Antibiotics – Diligent Restrained Use For A Secure Tomorrow (Part – 2)

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Antibiotics – “A savior if used judiciously, slayer if not!”

Early diagnosis and judicious treatment of bacterial infection is a must in order to prevent further spread or deterioration.  

With an effort to supervise judicious prescription of antibiotics by clinicians and followed adequately by the patients, “Antibiotic stewardship” program was brought into existence.  Stewardship programs are conducted by infectious disease specialists to create insight into above concerns by ensuring judicious use of antibiotics.

Also read Antibiotics – Diligent Restrained Use For A Secure Tomorrow (Part – 1)

“Judicious use” of Antibiotics – Rule of Five explains all

  1. Right Choice
  2. Right Dose 
  3. Right Interval between the doses
  4. Right Duration 
  5. Right Route (viz., oral or injection)
Five Rules – Right CDIDR !

Right Choice of Antibiotics

Antibiotics – A Magic Bullet; But Not for All! The choice of antibiotic depends on several factors like the site of infection, type of bacteria and so on.  For example, antibiotics prescribed for respiratory infection are different from those prescribed for gut infection.  And, even for respiratory infection, the choice depends on the site of the respiratory system involved.

Right Dose

The amount of antibiotic prescribed differs from patient to patient, especially in paediatrics, where the dose is calculated based on the body weight.  Parents need to be alert while the doctor explains the dosage and be vigilant while buying at the pharmacy.  Commonly noted errors: Syrups are available in different strengths.  E.g., Antibiotic A may be available in two dosages a. 125mg per 5ml and b. 250mg per 5ml; if the doctor has prescribed 5ml of antibiotic , 250mg per 5ml, and parent ends up buying 125mg per 5ml, the parent has inadvertently reduced dosage to half! End result – no response or partial response leading to further complications or drug resistance.

Right Interval

Between the doses: Some are taken once a day, some twice, thrice, or even four times a day depending on the type of antibiotic prescribed and the infection diagnosed.  It becomes necessary to strictly follow the prescription for optimal results.  

Right Duration

Antibiotics are prescribed for a specific number of days depending on the infection.  Many patients/parents fail to follow the exact number of days due to certain misconceptions like, “Off fever = Off Infection” or, suspicious thinking like, “Doctor has prescribed for 10 days, but previous doctor for previous infection had given for 5 days.  Maybe this is an overdose.  Better I shall stop at 5 days.” Or “Bottle empty = Course completed”, the syrups vary in concentration and the volume.  Most of the times, patients may need two bottles.  Parents may buy one with plans to buy the next one later.  By the time one bottle gets emptied, fever settles and parents too!  

Right Route

Antibiotics are given either by mouth or through injections. This “Tug of war” is a very well-known one in most of the in-patient care cases.  Let us say antibiotic injections ( when no oral alternatives are available) are planned for 10 days and by the 7th day child looks fine – this may prompt many to get discharged from the hospital before completing the injection counts. Needless to say this goes against medical advice.

If any of the rules is not obeyed either by the doctor or by the patient/parent, the savior can turn into slayer, either by allowing the bacteria to overpower the situation or by causing adverse effects.

Once the bacteria overpowers the situation, strains start developing resistance to antibiotics.  This forces the physician to go for higher antibiotics.  And, the vicious cycle continues till a day comes when we are left with no further choice of antibiotics.   In fact, we are already in this situation especially while taking care of hospitalized patients.  Antibiotic resistance is a global emergency, as the infections do not respect international borders.  Resistant microbes spread with the spread of population across the world.

Adverse effects – Most of the antibiotics have side effects like vomiting, diarrhoea, and abdominal pain.  Prolonged antibiotic use brings down the immunity, further exposing them to secondary infections like fungal or other bacterial or viral.  These are simple adverse effects. 

Serious antibiotic related life-threatening adverse reactions may happen, though rare – Slayer at its worst!

Heavy on pockets …too!

Higher on the use of antibiotics, heavier would it be on the pocket.  Antibiotics are a costly affair and on top of it they come with adverse effects. Forceful climbing up on the ladder of antibiotic potency, would result in the vicious cycle as mentioned above.  

For example, a simple viral fever could be taken care of with supportive care, which costs nothing but patience.  Adding on a fever control medicine, would cost anywhere between Rs. 10 to Rs. 50 depending on the strength.  Even a simple antibiotic would increase the cost by around Rs. 100 to complete the course. Higher antibiotics may be priced Rs. 250 onwards. The story does not stop here.  Most of the antibiotics cause diarrhea, so many would add probiotics and other supportive medicines to take care of adverse effects.  The fever which could have been treated with small amount may end up in thousands.  If financial costs are the tip of the iceberg, then adverse effects on long term health are the mountain beneath the surface, which may even prove fatal.

As the saying goes, “You cannot clap with one hand.”  It is the duty of both the physician and the patient/parent to judiciously use the antibiotic.  

“A Penny Saved Is a Penny Earned!”

Disclaimer:  The above article is only to create awareness regarding antibiotic use.  The given information should not be used as a substitute for doctor’s consultation in case of any clinical symptoms mentioned above.

Dr. Mallikarjuna Swamy H P

Practicing Pediatrician and Neonatologist. Originally hailing from Mysuru, he is practicing in Kuwait since 10 years.

12 Comments

  1. Avatar
    Dr Ramaswamy Reply

    Dr Mallikarjun aptly describes the safety issues concerning usage of antibiotics. In patient safety parlance the right drug at the right time in the right dose given to the right patient is very important in the right route. Improper usage of antibiotics has lead to the distressing trend of antibiotic resistance in clinical practice.
    This article is an apt continuum to his earlier write up on the subject

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much Dr. Ramaswamy for the quick reveiw.

      Regards.

      • Avatar
        Fahad Farooq Tonse Reply

        I was eagerly waiting for the second part after the well written informative part one .It was well worth the wait. Again it is clear,concise ,informative and explains precisely the problem and the solution. Hopefully it reaches and impacts as many people as possible to prevent a post-antibiotic era.

        • Dr. Mallikarjuna Swamy H P
          Dr. Mallikarjuna Swamy H P Reply

          Thanks much Dr. Fahad. Your review encourages me to continue writing.

          Regards.

  2. Avatar
    Dr Anupama Pujar K Reply

    Very well written. Right information to all, at right time as antibiotics used irrationally nowadays leading to increased antibiotic resistance.

    • Dr. Mallikarjuna Swamy H P
      Dr. Mallikarjuna Swamy H P Reply

      Thanks much Dr. Anupama for encouraging review.

      Regards

  3. Avatar

    It was very informative and appreciate your efforts to spread awareness to end users though being in same profession.

  4. Avatar

    Very well written doctor. For non medical professionals like me, it is very informative. I believe that not only the doctor even the patients should have some basic knowledge about the medicines. Thank you very much for the informative article. Waiting eagerly for your next blog.

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