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Interactive data visualizations of antibiotic use and resistance in North America and Europe
Antibiotic resistance is a stark reality across the globe, including in India. The challenges associated with controlling antibiotic resistance, particularly in India, are many and multifaceted. On one hand, antibiotics are necessary in many life-threatening cases. On the other hand, overuse of antibiotics can be disastrous in the long run. Hence, judicious use of antibiotics is required, but acceptable strategies to achieve this goal and to address the challenges must be devised and communicated.
Molecular-based detection of the drug resistance of indicator microorganisms is a challenge, as is monitoring their circulation in hospitals and in the community. An approach that integrates surveillance for drug resistant organisms in animals and humans is also a current need.
Another major challenge is the absence of a good monitoring or surveillance system for prescriptions. A rigid surveillance system for community- and hospital-based prescribing is the first step towards determining the magnitude of the problem and instituting appropriate remedial measures. Such a system would provide a window on the underlying trends in prescribing practices.
Prescription monitoring is indeed difficult, considering the vast Indian subcontinent. One feasible approach is to provide incentives to pharmacists to keep records of prescriptions dispensed and discourage their practice of dispensing antibiotics without prescriptions (especially common in suburban and rural areas) or out-of-date prescriptions. Changing the behaviour of pharmacists will be pivotal for the success of any campaign against misuse or abuse of antibiotics. They need to feel that they are part of the health system, rather than simply another business. Programs to educate the pharmacists in the critical area of drug dispensing need to be designed and implemented.
Another important issue related to drug dispensing is that many pharmacies are not owned or run by qualified pharmacists. The number of pharmacies licensed to a single pharmacist, yet run by unqualified personnel, has mushroomed. This has aggravated the problem of malpractice in drug dispensing, where the only goal is financial gains, and needs to be addressed legally.
Once a good surveillance system is in place, a national board should monitor all prescriptions. When this is in place, it should focus on physicians who inappropriately use antibiotics. As with pharmacists, changing prescribing habits is no easy task. Sustained efforts will be required to educate and re-educate physicians about the long-term consequences of antibiotic overuse. Here, technical issues need to be highlighted so that the physicians understand and appreciate the message.
Exacerbating this problem is the stagnation of the pharmaceutical industry in the development of new antibiotics. The lack of antimicrobial advances has led to the introduction of only one new class of antibiotics—the oxazolidinones—in the past three decades. One would think that knowing that the antibiotic armamentarium is on the verge of exhaustion would convince physicians to think twice before prescribing antibiotics.
While addressing the immediate concerns regarding antibiotic resistance should remain a priority, long-term goals should also be kept in mind. These include formulating strategies and incentives to kickstart new antimicrobial research and development by the pharmaceutical industry. Instituting effective public-private-partnerships may be crucial to initiate and sustain a strong antimicrobial drug pipeline over the long term. Again, all the foregoing efforts should occur simultaneously, in order to check misuse, abuse, or overuse of antibiotics.
Initiatives, such as the Global Antibiotic Resistance Partnership (GARP), should stimulate critical thinking and take the issue forward, so that the challenges are adequately addressed and, eventually, stabilization or even reversal of the antibiotic resistance pattern occurs—first regionally, then globally.