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Tuesday, October 29, 2013

Docs alarmed as antibiotics lose sting ‘Drug Resistance Could Make Treatment Of Severe Infections A Challenge’


New Delhi:Are we approaching the end of the antibiotic era? A statement to this effect by none other than the US's Center for Disease Control and Prevention has sent shock waves within the medical community here. The bacterial disease burden in India is among the highest in the world. Also, a significantly large population is at risk of secondary infections through non-communicable diseases necessitating antibiotics. This is almost a doomsday scenario. 
    Antibiotic resistance is a resistance of bacteria, such as E Coli, which causes gastroenteritis or urinary tract infections, to a drug to which it was originally sensitive. 
    "The end is nearing. We are forced to use older drugs with known side-effects to save lives because the current high-end antibiotics have become ineffective in some infections. The microorganisms have evolved at a higher speed than drug development," said Dr Sumit Ray, vice-chairman, critical care medicine at Sir Ganga Ram Hospital. 
    He added, "Colistin, a fourth-generation antibiotic developed in the 1960s, used to be forbidden in hospital-acquired infections as it damaged the kidney. But now we have to use it routinely." Health experts say no new groups of antibiotics have been developed since the 1990s. "Carbapenem is the 
last group of antibiotics developed worldwide. There have been modifications to the available antibiotics but no new drug has come up. This is despite an increase in drug-resistant microorganisms. The New Delhi superbug or New Delhi Metallo-BLactamose 1 (NDM1) is just one example," said Dr Ray. 
    Ramanan Laxminarayan, the vice-president for research and policy at the Public Health Foundation of India said antibiotic resistance is seen across the world. "But unlike the developed countries, our preventive measures are not as robust. Unavailability of clean drinking water and poor sanitation 
cause widespread infection, necessitating antibiotics," he said. Drug resistance is found in community and hospital acquired infections. 
    Dr Anoop Misra, chairman, Fortis C-Doc Centre for Diabetes, Obesity, Metabolic Diseases and Endocrinology, said drug resistance is common in bacterial diseases 
like typhoid, pneumonia, wound infections, etc. "There is no government control on the sale and purchase of even high-end antibiotics. People get it over the counter for common fever or diarrhoea," he said. He conceded that many private practitioners prescribe advanced antibiotics where it is not required. 
OUR BEST BET TO BEAT DISEASE & DEATH 
Have we entered the 'end of antibiotics' period? A statement made by the US' supreme body on health policies, Centre for Disease Control and Prevention, has sent shockwaves among the medical community. Here's why India must worry, and act: 

The bacterial disease burden in India is among the highest in the world Lack of clean drinking water & sanitation causes infections Diabetes, heart diseases and cancer—diseases that cause low immunity—are common New drug-resistant bacteria, such as New Delhi metallo-B-lactamose-1 (NDM1), found in the past 10 years Fungi, known to cause infection in critically-ill patients, are turning drugresistant, too, studies show 

WHAT NEEDS TO BE DONE Patients: Take antibiotics as 
    prescribed by doctors, avoid 

    self-medication 
Physicians: Prescribing antibiotics only when needed, surveillance of antimicrobial resistance and use, and practising infection control to prevent spread of drug-resistant pathogens 
Government: Strong policy measures, such as a ban on over-the-counter sale of high-end antibiotics 
WORST AFFECTED 
Cancer patients 
People receiving chemotherapy can quickly become serious due to infections; effective antibiotics are critical to save them 

Surgery cases 
Risk of infection at the surgical site is high in operations like cardiac bypass. In some cases, antibiotics are given to prevent infection 

Rheumatoid arthritis 
Infl ammatory arthritis affects the immune system; antibiotics are vital to check infections in patients 

Patients undergoing dialysis for end-stage renal disease 
Infections are the second leading cause of death in dialysis patients 

Organ and bone marrow transplants 
Recipients are vulnerable to infections. Antibiotics make organ transplants possible 

DISEASES AND CONDITIONS AFFECTED BY DRUG-RESISTANCE 
Tuberculosis 
Typhoid 
Staph infection in wounds and bloodstream, pneumonia cases 
Pseudomonas infection in urinary tract, abdomen and bloodstream 
Infections caused by E-Coli bacteria 
Hospitalacquired infections



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