'Antibiotic' literally means against life. They are agents that fight infections, by killing the infecting microbes or stopping its growth. All infections are potential threats to life. Antibiotics are largely responsible for improved quality of life and increased life expectancy, by checking and curing infectious diseases. But due to their use and abuse over decades, many antibiotics are no longer effective against infections by common germs. The World Health Organization has considered, “antibiotic resistance”, as one of the current top 10 global health concerns. The outcome of this is grave. It is getting more and more difficult to treat many common diseases like pneumonia, tuberculosis, gonorrhea, e.t.c, because antibiotics used are no longer very effective. Their use no longer kills infectious germs as well as before. Resistant infections can spread from one person to another manifesting in more severe disease. It leads to longer hospital stays, increased medical costs and increased mortality. Resistance is developing against not only drugs used to treat bacterial infections, but against anti viral, antifungal, i.e. all possible infectious agents. There are multiple reasons leading to antibiotic resistance. Microbes naturally develop resistance to antibiotics by mutations and changes in their genome. Resistance to Sulfonamides, a very effective group of antibiotics was discovered as early as 1930. But excess use of antibiotics over decades has accelerated this process. Antibiotics have been used everywhere from minor wounds ,cuts, abrasions, in treatment of major / minor diseases, used as floor cleanser, fed to livestock, used in veterinary, i.e so many situations. Self-medication is yet another reason for growing antibiotic resistance. Individuals buy antibiotics on their own and may also take in inadequate doses and for shorter durations, which makes the germs grow strong against used antibiotics. The challenge is that not much research is done in finding new antibiotic molecules by the pharma industry, as compared to those used to treat chronic non communicable diseases. Funding in this field is negligible and costs very high, hence pharmaceuticals shy from it. No new antibiotics have effectively been made for almost 30 years, when Carbapanems were launched. The new ones made are just alterations of any old molecule. In such a scenario, it is important to use antibiotics very judiciously to retain their effectiveness in killing infectious germs. There are situations where antibiotics are not needed and should be avoided. These are like the common cold, dry cough, and sore throats. These are mostly due to allergy, where anti allergy drugs alone suffice or due to viral infections, which subside on their own. Acute diarrhea is another such problem, which can be treated without antibiotics, unless it is severe and life threatening. The infectious microbes causing diarrhea or their released toxins are washed out from the body via loose motions. Minor cuts or wounds do not need antibiotics. In a healthy individual with good immunity, such wounds heal spontaneously without antibiotics. Just by keeping them clean and dry. In any suspected infectious illness, instead of starting antibiotics immediately, the sick person should be observed for 24 to 48 hours and investigated. Then he can be reviewed, regarding the need to start antibiotics. Specific indications to begin antibiotics are a high white blood cell count, i.e. leukocytosis, increased polymorphs, (cells which fight bacterial infection), positive C reactive protein, positive smears, culture, are indicators to initiate antibiotics. If started, antibiotics should be taken in the correct dose for the duration prescribed. Empirical antibiotic therapy should be given only in severe life threatening infections. Antibiotic resistance is a global threat to health and productivity as well. Hence the need is to make people aware of this threat. Judicious use of antibiotics shall make them effective tools to combat infections once again. Dr. Rachna Pande is a specialist in internal medicine rachna212002@yahoo.co. uk
