Says Dr. Prahlad Patki, professor of pharmacology at the B. J. Medical college, “Antibiotics are truly life saving and in fact they are the greatest success story in medical history, but we have to remember that the fight against microbes is a constant one. Just as we humans learn to survive in worst situations, so do these organisms. You use drug to kill them and they develop a resistance to them. After all it is a fight for survival for them”.
Because of chloramphenicol resistance, the medical fraternity had to shift to a higher generation anti–microbial, ciprofloxacins. But once again the typhoid causing microbes got stronger and developed a resistance to them. So doctors switched back to chloramphenicol. Microbes develop drug resistance because of several reasons.
Says Patki, “If drugs are used wrongly that is they are prescribed when they are not necessary, if they are not used in the proper dosage, it could be under or over dose, or if they are not taken in the correct form, that is using injectables instead of capsules and if the patient does not take the medication as prescribed, often forgetting doses, then we are actually helping the disease causing microbes get stronger”.
To this end, several diseases have received a boost from mankind. Besides typhoid, septicemias resulting from burns, Urinary Tract Infections and even Tuberculosis causing microbes have benefited. In these circumstances, it makes sense to use these life saving drugs rationally. Says Patki, “While the medical fraternity is constantly discovering newer drugs, it makes sense to have a rational approach towards drug use. In fact like the Western countries, we too should have an antibiotic policy that should be followed by all hospitals”.
Rational use of drugs would involve the cooperation of all hospitals. To evolve a policy, first of all there should be a determined effort from all doctors to curb the sue of unnecessary drugs. Then according to Patki, “Hospitals should restrict use of higher antibiotics and preserve these only for serious conditions”.
The other important feature in the rational use of drugs is the cyclical rotation of medications. “It is not necessary that everytime a resistance is developed, one has to depend on higher antibiotics. Sometimes the older drug could be just as useful. take Typhoid for example. After chlormphenicol, doctors had to depend on Ciprofloxacin, but after about five or six years the microbes get resistant to this and chloramphenicol then becomes effective. This works well with septran also”.
Also hospitals should get involved in the prevalence of resistance patterns in a particular locality. This would help doctors know what drug should be used at what time and where. This a feeling that even Dr. John Almeida, consulting physician, agrees with. Says he “I feel that we should get the major pathology labs involved in this exercise. They do these culture tests for day to day infections like sore throat, pneumonias, diarrhoeas, and so on. If we simply record these results, we would know which drug to use when and where. Also this kind of an effort would be useful in developing prescribing guidelines for general organisms that are of national and international interest like malaria, typhoid, TB and so on”.
It is time to join hands and give the disease causing bacteria a tough fight. After all it is them versus us.