The first thing many doctors prescribe for almost any medical problem is an antibiotic. They are being prescribed even in cases where they are useless and even when they are useful, they are being prescribed for far longer periods than is necessary. The medical fraternity is finally waking up to this tremendous misuse of antibiotics.
Antibiotics work only when infections are caused by bacteria. But many infections are caused by fungi (ringworm, athlete's foot, yeast infection, etc.) and by viruses (common cold, most coughs, dengue, swine flu, chikungunya, etc.) and even though antibiotics are useless against these infections, they are very commonly prescribed for these diseases. Such inappropriate use of antibiotics has the dangerous consequence of creating bacteria which are resistant to antibiotics. When bacteria become resistant to antibiotics, curing bacterial diseases becomes very difficult and there is a heightened risk of deadly epidemics. It will be a throwback to the middle ages when millions perished from epidemics of cholera and plague. Center for Disease Control and Prevention (CDC) of the USA calls antibiotic resistance of bacteria one of the world's most pressing public health problems. In an attempt to stop this problem from escalating further, CDC began a campaign in 2003 to educate the doctors in the US on the dangers of inappropriate use of antibiotics and to discourage them from such use. Starting in 2008, CDC is observing one week in a year as the "Get smart with antibiotics" week. The "Get smart with antibiotics" week this year is being observed this week (15-21 November) and doctors are being urged to be economical with antibiotic prescriptions. UK and France also have national campaigns against misuse of antibiotics. But no such campaign to limit antibiotic use in India seems to have been launched till now.
As if misuse of antibiotics is not enough, routine excessive use of antibiotics has now come to light. When you go to a doctor with a problem which requires antibiotics, the doctor will prescribe the medicine for 7 or 10 or 21 days. When you start taking the medicine, you find that all the symptoms disappear after 4-5 days and you stop taking the antibiotic assuming that you are cured. If the doctor finds that you have stopped taking the medicine, he is sure to berate you severely for not taking the full course prescribed.
But does the doctor have any basis for determining what a full course for an antibiotic is? The answer amazingly is NO! It appears that the guidelines issued by various medical bodies on how long an antibiotic should be taken are not supported by any solid scientific evidence at all! Instead, they are based on what the drug manufacturers recommend and since the manufacturers want to maximize profit, they naturally recommend long treatment durations.
A detailed study conducted in the Netherlands and published in the British Medical Journal in 2006 (BMJ 2006;332:1355) provided the first scientific evidence for fixing the duration of a antibiotic course. It found that for certain types of pneumonia, discontinuing the antibiotic treatment after 3 days was just as effective as 8 days (which is the normal prescription). This shocked the medical world which thought till then that 8 days treatment was absolutely essential to cure the disease. But the evidence presented by the study was so compelling that, despite strong opposition from the drug industry, the medical fraternity was forced to launch scientific studies to determine the optimum antibiotic therapy duration for other medical problems.
Conducting such studies is a long and tedious process and so all the results are not in yet. In research reported in Archives of Otolaryngology in 2009, it was found that a 3-day course of antibiotics after pediatric tonsillectomy is as effective as a 7-day course. In another research, it was found that a 3-day course of antibiotics for middle ear infection is as effective as a 5-day course and as a result the World Health Organization, in 2009 reduced its recommended duration for middle ear infection treatment to three days. As new research results trickle in, it is certain that treatment periods for all antibiotics will be reduced, some drastically.
But it does not appear that these scientific research results are being reflected in prescriptions in India. As a result, in India, antibiotics are being prescribed for too long a period (and for the wrong diseases, as mentioned earlier). It is imperative that Continuing Medical Education programmes educate the doctors here on misuse and excessive use of antibiotics. It may be difficult, because many large drug companies are aggressively marketing their antibiotics and any effort to limit their use will be vehemently opposed. In the USA, in light of the research cited above, the government has tightened the guidelines for clinical trials of antibiotics and the drug companies are threatening to stop manufacturing antibiotics altogether. One can only imagine the lengths to which they will go in India to protect their interests.
According to the bestselling "The ICU Book" by Dr. Paul L. Marino, there are two cardinal rules concerning antibiotics, try not to use them, and try not to use too many of them. Consumers should be aware of these rules, which seem to be routinely violated in practice. This might be one reason why bacteria (containing the gene NDM1) which can resist almost all antibiotics, including the very powerful carbapenems, is widespread in India. If this trend is not reversed immediately, we could be facing deadly uncontrollable epidemics very soon.
C.V.Nagaraj, member, Mysore Grahakara Parishat