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EDITORIAL
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 1-2

Rationalizing antibiotic use through a robust policy, antibiotic stewardship, and pharmacokinetic-pharmacodynamic principles


Department of Microbiology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India

Date of Web Publication25-May-2018

Correspondence Address:
Reba Kanungo
Department of Microbiology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_8_18

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How to cite this article:
Kanungo R. Rationalizing antibiotic use through a robust policy, antibiotic stewardship, and pharmacokinetic-pharmacodynamic principles. J Curr Res Sci Med 2018;4:1-2

How to cite this URL:
Kanungo R. Rationalizing antibiotic use through a robust policy, antibiotic stewardship, and pharmacokinetic-pharmacodynamic principles. J Curr Res Sci Med [serial online] 2018 [cited 2018 Jun 24];4:1-2. Available from: http://www.jcrsmed.org/text.asp?2018/4/1/1/233207



Exponential rise of multidrug-resistant strains of common bacteria have become a challenge to antibiotic therapy in hospitals as well as in the community. Mortality due to infectious diseases in India is 416.75/100,000 persons.[1] Several reasons are attributed to this; particularly in India, it is the absence of a policy governing the prescription, dispensation, and procurement of antibiotics in health-care setups, barring some hospitals both in the public and private sector. This in turn stems from the lack of information on the trend of antimicrobial susceptibility among commonly isolated bacteria in hospitals, leading to uncertainty on what to prescribe and what not to.

Use of local data is crucial for formulating a policy. However, the data must be appropriately presented. Many laboratories present simplistic data based on inappropriate sample and testing methods, without a realistic denominator, and faulty interpretation, without the use of standard analytical tests. A major drawback is the antibiotic susceptibility test results of colonizing bacteria which are misleading. Quality of laboratory tests is often poor, leading to erroneous results. The techniques, reagents, and procedures play a vital role in accuracy of test results. As a first step in the development of an antibiotic policy, quality of data must be reviewed, analyzed, and disseminated. This must be followed by regulatory mechanism at various levels which include the prescribers (both junior and senior doctors), the procurement bodies (either the hospital or pharmacy), and finally, efforts to review patient compliance. The policy must include mechanisms for controlled antibiotic prescribing, restrained use of unnecessary antibiotics, restricted procurement of expensive antibiotics, and finally ensuring appropriate therapy. The guideline must also include special needs in different areas of the hospital and its units and cater to different categories of patients.

An antibiotic stewardship program will help optimize treatment and reduce adverse effects of antibiotics in acute care units. These programs also help the clinicians and hospitals to reduce cost and improve patient safety through cure of infections. Adherence to antibiotic policy on correct prescription for therapy and prophylaxis reduces treatment failures, thereby reducing antibiotic resistance. Prescription auditing will help in identifying weak areas in the chain for rectifying and streamlining the process. This brings us to an important aspect of the appropriateness of antibiotic therapy. The success or failure of antibiotic treatment depends on the interplay of three factors: the patient, organism, and antibiotic. Influencing the complexity of interactions between patient and antibiotic are the pharmacokinetics of the drug. The pharmacodynamics, on the other hand, depends on the interplay between the organism and the antibiotics. Together, these are known as the pharmacokinetic-pharmacodynamic relationships of antibiotics. Each antibiotic has its own pharmacodynamic profile based on the inhibitory or “cidal” effect on the bacteria which need to be optimized for patient outcome and preventing resistance. This is a dynamic process as profiles change over time, requiring frequent review and changing the dosing schedule for optimization of treatment.

To monitor these changes and create awareness among prescribers, an antibiotic stewardship program in hospitals is thought to be the way forward. However, this approach needs to address the prescribing autonomy of the clinician. An interesting article by Sikkens et al. highlighted that an approach based on prescriber autonomy resulted in an increase in antimicrobial appropriateness.[2] Awareness needs to be created among health-care providers regarding factors that can influence the success or failure of antibiotic therapy.

The National Treatment Guidelines for Antimicrobial use in Infectious Diseases published in 2017 by the Ministry of Health and Family Welfare, Government of India provides a comprehensive guide to antibiotic treatment of infectious diseases, with specialty-wise focus on individual situations. This document will help hospitals develop their antibiotic policies. There is an urgent need to pay attention to the rapidly increasing antibiotic resistance in health-care setups across India. We have come a long way after the denial and outcry of New Delhi metallo-beta-lactamase1 (NDM-1) to the present, where we are grappling with ways to prevent colistin and vancomycin resistance. Rational use of antibiotics through change in prescribing behavior, implementation of regulatory mechanisms to curtail and monitor irrational use, and dispensation of antibiotics for human and animal use are mechanisms that need priority attention, if we hope to arrest the tide of antibiotic resistance in health-care practice.



 
  References Top

1.
Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis 2013;13:1057-98.  Back to cited text no. 1
    
2.
Sikkens JJ, van Agtmael MA, Peters EJ, Lettinga KD, van der Kuip M, Vandenbroucke-Grauls CM, et al. Behavioral approach to appropriate antimicrobial prescribing in hospitals: The Dutch unique method for antimicrobial stewardship (DUMAS) participatory intervention study. JAMA Intern Med 2017;177:1130-8.  Back to cited text no. 2
    




 

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