What Medical Students Should know About Antibiotics?

Dr.T.V.Rao MD
The discovery of antibiotics in the 1940s has heralded a new age for peoples health. These amazing new treatments could cure illness and even prevent deaths. The vast majority of deaths before the mid-20th century were caused by microbes bacteria, amoebas, protozoans or

viruses that ruled the Earth and to a lesser extent still do. Its not always clear which microbes get the
credit for which kills. Thanks to germ theory of disease, didnt catch on all that quickly, but once it did, people started washing their hands. Soap became cheaper and more widespread, and people suddenly had a logical reason to wash up before surgery, after defecating, before eating. Soap stops both deadly and lingering infections; even today, kids who dont have access to soap and clean water have stunted growth. The curriculum on Antibiotics is taught to Medical Students as core subject in Pharmacology , just mentioning the names of different Antibiotics in Microbiology with greater clinical teachings and applications in Final years of MBBS, Yet there is not topic in integrating the consequences of using, misusing, and the consequences of Antibiotic use. In the residency or House surgeon ship programme, of 1 year, one rapidly rotates between the departments, before they get a hold on learning the prescribing trends in Antibiotic prescriptions. Major studies have identified including WHO that little of the matters are taught on Misuse of antibiotics and the consequences, which lead to poor status on Antibiotic prescriptions, lacking scientific prescriptions. We are turning the Doctors with lacuna in use of antibiotics for full-fledged Medical practice, and young Doctors are guided by Medical representatives, as they believe, to catch them young to turn the business a success. Every one aggress todays economic development and progress and reduction of, morbidity mortality is associated with rationalistic prescription of several antibiotics. In spite of millions of lives have been saved by antibiotics, but what if they did not work any longer? What would we do? Unfortunately, we are coming face to face with that problem as various microbes become resistant to major groups of antibiotics. The Young Doctors should realise, Viruses, on the other hand, do not respond to antibiotics. While responsible for illnesses like coughs, sore throats, most ear infections and the common cold, all are virus-caused and none will respond to antibiotics. In other words, being sick does not automatically mean you need antibiotics, it has been observed that young Doctors switch to antibiotic use, majority studies prove that many of prescription of the Genera physicians are included with antibiotics, Over time, bacteria can change and become completely resistant to a whole class of antibiotics. Once resistance has been reached, defeating the resistant bacteria means having to use more and more powerful antibiotics. One example of this resistance is methicillin-resistant Staphylococcus aureus, or MRSA. This is one type of staphylococcus infection that is resistant to most antibiotics. It has become a so-called super-bug that is very difficult to cure, and continues to be an important cause of Nosocomial Infections. There are even more resistant bacteria, and new antibiotics are coming along more slowly which are expensive and attain the resistance if used without caution. In the past the hospitals in west were afraid of having MRSA in their wards even they prefer to close the wards, in developed countries, however we rarely bother and fail take steps to control the spread. The young doctors would be ideal ambassadors to promote the knowledge on Vaccines and their usage, as vaccines have almost eliminated diseases that used to be common killers, but she points out that theyre still circulating in other parts of the world, and if we dont continue to vaccinate, they could come back. Some credit for the historical decrease in deadly diseases may go to

the disease agents themselves. Some fortunately disappeared like plague, small pox with

successful vaccination by WHO, and giving way to newer pathogens, which are turning out be Drug
resistant which were not considered as potential pathogens in the past, never forget many uncommon microbes are encroaching on Humans. Todays challenge continues with majority of Gram negative

bacteria, A recent Centres for Disease Control and Prevention study identified increasing resistance
to a class of drugs called Cephalosporins, which are commonly used to treat severe Salmonella infections in adults and are the main drug of choice when treating children, for whom the fluoroquinolone class of drugs is not recommended. The CDC study found that the main mechanism of resistance to cephalosporins is the production of beta-lactamases, which are enzymes that manage to inactivate the antimicrobial agent. Of concern to the researchers is the fact that the genes related to antimicrobial resistance are often mobile, moving between bacteria and Salmonella serotypes, humans and animals. I wish we the medical professionals alone need not be blamed for the ills associated with Antibiotic resistance, improper agricultural, and vet nary use of antibiotics is often blamed as a main contributor to the problem of drug-resistant Salmonella, but other studies have failed to find evidence that these practices contribute to increased antibiotic resistance. Other theories for the development of resistance exist, such as improper use of antibiotics among humans, or even, the spread of antibiotic-resistant clonal types not influenced by antibiotic use in animals or humans. The real threat of Antibiotic resistance fall on the patients admitted in the Hospital even with trivial conditions. However, major overuse has led to the problem of antibiotic resistance, where by major infections build up a resistance to drugs that have been used over a long period of time and in great numbers. As a result, many antibiotics are becoming less effective at treating infections in India and worldwide. This can be a particularly serious problem in hospitals, where patients who have had procedures, or who are getting major surgery, or are in intensive care, are prone to developing 'super

bugs' that are resistant to many antibiotics. These can cause serious illness and death. Current
concepts to put a stop to use of antibiosis in a defined period and not making the patients to use the Antibiotic erratically ,the researchers developed a new prescribing protocol for these patients, which included automatic stop dates, with time limits on prescriptions depending on the severity of an infection. In other words, people with more severe infections would take the drugs for longer periods than those with milder infections.

The following have been identified as important strategies to contain Antibiotic Resistance
Improve how we prevent and manage infections in people and in animals; including through better hygiene and monitoring of bacteria in medical and community settings, and through better farming practices. Improve education and training around the prescribing of antibiotics to reduce inappropriate usage and make sure patients get the right antibiotics, at the right time and for the right duration. Collect better data on the resistance of bacteria, so we can track them more effectively, find the most resistant bacteria and step in earlier where there is resistance to antibiotics. Better documentation of Antibiograms and informal Audits of Antibiotic usage and drug resistance patterns can help us to know the changing trends on concerns on Antibiotic misuse.

Never forget Antibiotics are no longer the ultimate Magic bullets, just drugs to control defined infections. Evidence based prescriptions of Antibiotics may save many lives and reduces the Antibiotic Resistance.
Dr.T.V.Rao MD Professor of Microbiology, free-lance writer Email doctortvrao@gmail.com