Rational Use of Antibiotics: An Area of Concern

Most of the IPD (Inpatient department) and OPD (Outpatient department) patients receive a course of antibiotics either for treatment or prevention of infection or during discharge. The therapeutic outcome with an antibiotic depends mostly on choice of appropriate agent. The selection of antibiotic depends on causative agent, patient factors, clinical pharmacology of antibiotics and its cost effectiveness. Antimicrobial resistance (AMR) occurs when microbes like bacteria, parasites, viruses and fungi become resistant to antimicrobial drugs that are used for treatment of various diseases leading to decreased effectiveness, difficulty in treatment of disease and hence requiring multiple therapeutic options. Antimicrobial stewardship is a coordinated intervention, designed to improve and measure the appropriate use of antimicrobial agents, by promoting the selection of optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration. To strengthen the implementation of rational antibiotic use and reduction of antimicrobial resistance, WHO (World Health Organisation) in 2019 introduced “AWaRe” classification of antibiotics that includes details of 180 antibiotics classified as Access, Watch or Reserve, their pharmacological classes, Anatomical Therapeutic Chemical (ATC) codes and WHO Essential Medicines List status. One health approach is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and environment. Recently, WHO issued new guidelines regarding the use of antimicrobials in animals producing food, recommending the restricted use of such medicines in growth promotion or prevention of disease in healthy animals. Hence rational use of antibiotics is important for successful treatment outcome and prevention of emerging drug resistance for broader community.