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closeA step towards increasing the rational use of antibiotics : Need of the hour.
Posted by DrSangeetaBhanwra on 17 Feb 2020 at 10:12 GMT
Sir,
The rapid emergence of antibiotic resistance is a serious global threat these days. It is due to the overuse and misuse of the antibiotics. In the present study, the authors have taken up a very important and relevant issue and also a method to tackle this problem, by applying the decision rule. The exploratory analyses done in the present study showed that fewer antibiotics were prescribed in low/intermediate-risk children, after applying the decision rule and the antibiotic prescriptions were better targeted to the children, who actually benefited from these antibiotics.
Studies have revealed over the period of time, that nearly 50 % of antibiotics used in the hospitals are not required and are being prescribed unnecessarily. It is well known that, Some of the commonly prescribed antibiotics used can lead to severe adverse drug events. The US Food and Drug Administration (FDA) issued a warning about azithromycin that it could lead to potentially fatal heart rhythm irregularities and about fluoroquinolones because of disabling and permanent side effects, including tendonitis, tendon rupture, aggravation of myasthenia gravis, peripheral neuropathy, and central nervous system side effects like psychosis. There could be a number of adverse drug reactions with other group of antibiotics, for example nephrotoxicity, serious secondary infections like C difficile infections, gastrointestinal disturbances, neurological or psychiatric effects etc. According to The Centres for Disease Control and Prevention (CDC) for every 1000 outpatient antibiotic prescriptions, one emergency department visit for an antibiotic associated adverse drug event occurs.
To reduce the inappropriate and irrational use of antibiotics, a multidisciplinary approach in the form of Antimicrobial Stewardship comprises of an ‘optimal diagnosis, drug selection, dosage, de-escalation and duration’ (5 “Ds” of antimicrobial stewardship) should be followed. This programme improves the treatment of infection, minimizes the adverse effects as well as reduces the development of bacterial resistance.
Measures like patient education, prescriber education in the form of training in communication skills, accurate diagnostics, active monitoring can be some more steps towards rationalising the antibiotic use.
References :
1. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ 2018;363:k3047. https://www.bmj.com/conte...
2. US Food and Drug Administration. FDA Drug Safety Communication: azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms. US Department of Healthand Human Services, FDA, 2013.
https://www.fda.gov/downl....
3. US Food and Drug Administration. FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. US Department of Health and Human Services, FDA, 2016.
https://www.fda.gov/Drugs....
Regards,
Dr. Sangeeta Bhanwra, Dr. Rajiv Kumar
Faculty, Department of Pharmacology,
Government Medical College & Hospital,
Chandigarh, India.