WHO says a lot needs to be done by the countries to combat antibiotic resistance

"While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time." - Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. Dr. Keiji Fukuda also added that antibiotic resistance is the single greatest challenge in infectious diseases.

A survey was completed by 133 countries in 2013 and 2014 which captured the individual Government's own assessment of their responses to antibiotic resistance issues especially to blood borne infections, tuberculosis and HIV related infections. The survey revealed an appalling truth that only 34 out of 133 participating in the survey had any national plans to combat antibiotic resistance to antibiotic agents.

The exact situation might be far worser considering only 8 nations of the 47 member nations participated in the survey from the African Region. The issues of antibiotic resistance is rampant in African region. 

The encouraging aspect of South East Asian region was that all 11 member nations participated in the survey of which 5 out of 11 nations had a national plan to combat antimicrobial resistance. 

One more challenge that was revealed was that health workers comply poorly with prescribing standards and guidelines.

"Sequential antibiotics" or "Antibiotic Switching" may help avoid antibiotic resistance

Contributed by Dr. Akilesh Ramasamy & Dr. A. J. Tamhankar

Sequential use of antibiotics could have synergistic effect to avoid development of antibiotic resistance or even combat already resistant bacteria. While the use of combination of antibiotics has always been used for their synergistic effect, the use of sequential use of synergistic antibiotics is a new approach by Fuentes-Hernandez et al.(1) The first antibiotic sensitises the organism and the second antibiotic delivers the killing shot. While premature exhilaration on this finding should be limited as this study has found only about 6 sequences which have been found to be effective after trying about 139 different sequences. The study is in it's infancy stage but gives us a new approach to dealing with antibiotic resistance as the technique succeeded in clearing bacteria which had partial resistance to both the antibiotics. 

The results must be viewed with caution as the study has been done in-vitro and it is a known fact that bacteria could behave differently when inside the host. Moreover, the correct sequence and the doses could be important. In that scenario, the use of antibiotics at the exact dose and at specific exact times might be important for the sequential treatment to succeed in humans. The practical implications are numerous as in an already overloaded healthcare setting, there is a high chance that a particular dose might be missed, delayed or given early thus thwarting the entire exercise. So, new formulations or techniques of drug delivery agents might come up which release the particular dose of antibiotic at particular sequence and time. These developments are possible if the sequential antibiotic treatment is found successful in humans. In addition, it also gives hope to the old antibiotics which have been discarded due to development of almost universal resistance to them.

Source:

1: Fuentes-Hernandez A, Plucain J, Gori F, Pena-Miller R, Reding C, Jansen G, Schulenburg H, Gudelj I, Beardmore R. Using a sequential regimen to eliminate bacteria at sublethal antibiotic dosages. PLoS Biol. 2015 Apr 8;13(4):e1002104. doi: 10.1371/journal.pbio.1002104. eCollection 2015 Apr. PubMed. PMID: 25853342. http://www.ncbi.nlm.nih.gov/pubmed/25853342

Adherence to surgical guidelines can lessen antibiotic resistance, cost and complications - A study confirms.

Contributed by: Dr. Akilesh Ramasamy & Dr. Tamhankar

Due to increasing levels of antibiotic resistance, the routine use of post surgical antibiotics is being questioned in various specialties. For instance, I have already pointed out in my review (1) that use of antibiotics after routine or even complicated tooth extractions in dentistry do not require routine use of antibiotics unless accompanied by space infections. Other surgical specialties also have come up with guidelines in this regard. In a recent multi-centric study involving urosurgical procedures, the investigators started following the guidelines of using only prophylactic antibiotics prior to the procedure. No post surgical antibiotics were used in the post operative period.

Comparing the infection rates retrospectively with previous cases (where antibiotics were used routinely in the post operative period), they found that the infection rates among the two groups did not differ significantly, suggesting that routine use of antibiotics is not necessary.(2)

Antibiotic use is associated with increased costs of treatment, more antibiotic related adverse events and development of antibiotic resistance. So, avoiding antibiotics for unnecessary indications can cut down on the costs, complications and antibiotic resistance. This is important on two main fronts. First, the cost of healthcare is ever increasing. Wastage in the ways of unnecessary treatments / antibiotics can decrease the costs of healthcare. India's Health Policy 2015 Draft aims to make healthcare accessible and affordable. In this regard we must take action and note to cut down on unnecessary prescriptions, unnecessary diagnostic tests and unnecessary procedures. Not only do they add to the costs of the treatment but also are potential issues of patient safety. Every procedure, test or medication adds to possible risks in the treatment of the patient. So avoiding those that are not essential can also contribute to safer high quality care with minimal wastage of resources.

Source:

(1) Ramasamy, Akilesh. “A Review of Use of Antibiotics in Dentistry and Recommendations for Rational Antibiotic Usage by Dentists.” The International Arabic Journal of Antimicrobial Agents 4.2 (2014): imed.pub. http://dx.doi.org/10.3823/748

(2) European Association of Urology. "Changes in surgery methods significantly reduces antibiotic  resistance." ScienceDaily. ScienceDaily, 20 March 2015. <www.sciencedaily.com/releases/2015/03/150320221049.htm>

‘Spreading Hygiene through Flying Kites’

Indian Initiative for Management of Antibiotic Resistance (IIMAR) is a participant in the Indo-Swedish project ‘APRIAM’ being implemented at the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. The full title of the APRIAM project is “Antibiotic stewardship program including infection prevention and control and waste water treatment: Implementation research in hospital and community in India.” 

 

Hygiene team of Project APRIAM is working with a slogan- “Swachch Bharat - Swasth Bharat” (Clean India- Healthy India). The Campaign is being run since 2010 at R. D. Gardi Medical College, Ujjain, Madhya Pradesh, India in collaboration with Karolinska Insitutet, Stockholm, Sweden.  The aim is to achieve the goal of Healthy India by keeping India clean. The team is led by Dr. Megha Sharma, Assistant Professor, Department of Pharmacology, R. D. Gardi Medical College, Ujjain.  It has been organizing activities both at hospitals and at community level in the Ujjain district of Madhya Pradesh. The long term aim is to conduct similar activities within various Indian states.

For advancing the message of “Swachch Bharat - Swasth Bharat” further, the team came up with an idea to spread awareness of the message to maintain hygiene through flying Kites. On the auspicious

occasion of Makar Sankrati (14 January 2015); the District collector, Ujjain organized a Kite festival at Dashehara maidan in Ujjain. The APRIAM team planned to take advantage of the opportunity to spread the message of "Be safe- Stay clean" with-in the campaign “Swachch Bharat - Swasth Bharat” among the visitors to the function. The APRIAM Hygiene team set-up 5 information desks at the function place, where over 1500 residents between ages 3 to 83 years visited. The team took advantage of these visits to educate and remind them to maintain self hygiene and general cleanliness and encouraged them to fill in a "Cross word puzzle" and participate in "Check your knowledge on hygeine" contest. Posters with messages of 'How and When to wash hands?',

were displayed at the site. Kites printed with message

 “Swachch Bharat - Swasth Bharat” in Hindi were distributed to 540 participants. Over 1000 residents participated in the other activities.

All entries were checked for their correctness level and all correctly filled entries were sorted out. The prize winners were selected through lottery system two times for each activity and prizes were distributed during the function. The team members Mr. Amit Pawar, Mr. Jeetendra Jat, Dr. Pintoo Marmat, Dr. Kamal Kishore Parmar, Ms. Sunita Parmar, Mr. Abdul Shadab, Ms. Pooja Bhati, Ms. Deepmala Lalavat and Mr. Lakhan Elunia contributed towards  the success of the event.

Contributed by: Dr. Megha Sharma & Dr. A.J. Tamhankar
 

Antibiotics may promote biofilm formation

Contributed by: Dr. Akilesh Ramasamy & Dr. Tamhankar

From Wikipedia site

A few research findings in the past  have indicated that antibiotics may have an effect on formation of a biofilm. In other words,  antibiotics may act as a stimulant for formation of biofilms.

What are biofilms?

Biofilm means that bacteria can join together on essentially any surface and start to form a protective matrix around their group.

 Biofilms and diseases

Biofilms have been implicated in a number of life threatening infections; for example  biofilms present on/in medical devices, tubings and even drains. Biofilms are tenacious and resist normal cleaning methods and chemical actions. It is a well known fact that biofilms show 1000 fold resistance to antibiotics than isolated organisms.

Antibiotics may favour biofilm formation

But increasing evidence points that biofilm formation may be stimulated by antibiotics. In a recent publication in PNAS, Rachel et al (1) have shown that thiopeptide antibiotics (a common antibiotic secreted by a number of bacteria) actually stimulate biofilm formation in Bacillus subtilis. This is independent of their antibiotic activity.
This is not a new finding though.

Siva wu et al in 2011 had reported that beta-lactam antibiotics stimulate biofilm formation in Haemophilus influenzae which are commonly involved in ear infections like otitis media when used in sub-therapeutic doses. This is a common scenario when antibiotic is improperly administered (improper dosing, improper frequency and duration etc;).