Antibiotics become an essential part of our modern medical science. Many time doctors has prescribed you antibiotics to treat you from an infection, but do you know it may leads to antibiotic resistance to specific micro-organisms for which those antibiotics are being used.
Click here to read in Hindi
World Antibiotic Awareness Week held every November since 2015 with the theme “Antibiotics: Handle with care” by WHO to spread awareness about anti biotics.
Before jumping to resistance lets know some basics about Anti-biotics.
What are Anti-biotics?
Antibiotics (Anti- Against, Biotic- microorganism)
It is a type of Antimicrobial agent (Synthetic as well as naturally obtained drugs that attenuate or destroy the variety of infective microorganism), which is produced by microorganism, semi synthetic and synthetic methods to kill or inhibit infective bacteria at very low concentration.
Okay. You can understand it in a easy way as, “Antibiotics are used to kill or inhibit micro-organism to treat you from infection.“
How Anti-biotics act?
Mode of action of any antibiotics can be specific to the type of micro-organism to be killed or inhibit. Most of the antibiotics act on:
1) Bacterial cell wall
2) Metabolic processes of bacteria like folate synthesis that is not found in the host
3) Microbial biomolecules inactivation (e.g. trimethoprim for bacterial dihydrofolate reductase)
What is Anti-biotic drug resistance?
It is a type of phenomenon where microbes are not responding to the antibiotic drugs. Or you can say that in a particular dose an anti-biotic is not sufficient to kill or inhibit that specific micro-organism.
Image: Antimicrobial resistance by WHO
Effects of Anti-biotic drug resistance:
Antimicrobial resistance is a matter of concern, because
- As it may cause infection for longer duration, disability, and death
- High risk situation for major surgeries, organ transplantation, cancer chemotherapy, diabetes management
- Increases the cost of treatment, prolonged stay in hospital and special care
- Resistant microorganisms can spread from human to animals, human to human
Antibiotic resistance rates of various organisms in India:
Image: from article “Antimicrobial resistance in India: A review” by S. Ganesh Kumar published in ncbi
Why Anti-biotic drug resistance occur?
Drug resistance can be based on various factors:
- Frequent use of antibiotics for non-severe conditions (e.g. cough, cold, fever, minor cut and injury)
- In some instances, resistance is also occurred due to use of less potent antibiotics for sever conditions
- Many instances after multiple uses of a drug for longer duration, microbe getting mutated (A permanent change in the DNA) and become tolerant or less sensitive to the drugs
- Resistance is also occurred with transfer of gene from one strain to another strain
- Few bacteria are releasing some chemical which antagonizing the effect of actual drug
- Bacteria are also capable to obstruct the entry of drug by their hydrophilic walls
Antibiotic resistance development:
Image: from article “The Antibiotic Resistance Crisis” by C. Lee Ventola published in ncbi
How to reduce the Anti-biotic drug resistance?
- Avoid using Antibiotics for inappropriate duration (Longer or less than the desired)
- Prefer rapidly acting and selective (Narrow spectrum) Antibiotics. Broad spectrum should be used in only suitable or critical condition
- Suitable combination of Antibiotics should be used for prolonged therapy (e.g. TB, AIDS)
- Strict policies should be there for provider and consumer
- Prescriber, dispenser and consumer should be aware about the proper use of antibiotics
- Education and awareness program should be organized for doctors, nurses, pharmacist, other HCPs and consumers
If a microbe is resistant to the antibiotic which is used to treat previous infection in the same host, called as superinfection.
Superinfection is difficult to treat and more common when host defence is compromised. If we are using broad spectrum Antibiotics (e.g. tetracyclines, chloramphenicol, ampicillin, newer cephalosporin), they are disturbing flora of good bacteria (existing in some parts of our body for natural defence to act against pathogenic bacteria) and hence, its increasing the pathogen and causing superinfection.
Usual Sites of superinfection are those that normally harbor commensals (bad bacteria derives benefits like food without harming or benefiting the host bacteria), i.e. oropharynx; intestinal, respiratory/genitourinary tracts and occasionally skin.
Prolonged use of Antibiotics can cause deficiency of Vitamins, produced by good bacteria (e.g. Vit B complex, Vit K of our intestine)
How antibiotics prescribed:
It depends upon various factors like-
- Patient Age
- Renal/hepatic function
- Drug allergy
- Impaired body defence mechanism
- Prophylactic use in case of surgery
Particulars of the infecting organism (e.g. sensitivity to the drug, strain, severity of infection), and the drug (spectrum of activity, type of activity (e.g. Bactericidal/ bacteriostatic), sensitivity to pathogen, toxicity, action of body on the drug, route of administration, cost as well)
Why Antibiotic combination preferred for critical conditions?
- To achieve optimal therapeutic effect/Synergism
- It can reduce severity or incidence of adverse effects by the use of lower dose to make the combination.
- To avoid the occurrence of resistance by simultaneous action of two different drugs
- To broaden the spectrum of antimicrobial action by acting on mixed infection and different strain
Antibiotics in pregnancy:
Avoided in the pregnancy because of risk to the fetus.
Only few are safe during pregnancy depend on condition e.g. cephalosporins, Penicillins and erythromycin.
Mostly are contraindicated due to unavailability of sufficient safety data. Below are few example of contraindicated ANTIBIOTICS:
Tetracycline, Aminoglycosides, fluoroquinolones, cotrimoxazole, chloramphenicol, sulfonamides and nitrofurantoin.
Its the responsibility of everyone to use Antibiotic with caution. Doctors and health care professionals should educate their patient. Also we should take care while using antibiotics regarding duration, frequency, dosing etc.
You can get more information on drugs use in our Meds corner section or click here to go directly.
This article shows how important to know about Antibiotics as these medicines become part of mankind.
Hopefully, it gives you an idea to be aware of antibiotics uses, However if you have any doubt please ask in the comment box.