Prevention is better than cure, but taking this adage to the extreme in the practice of medicine might obnubilate the very purpose of treating patients to recovery, and even turn out to be counter-productive. In the case of prophylactic use of antibiotics, the resultant antimicrobial resistance (AMR) will be deadly. The ‘First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22’ conducted by the National Centre for Disease Control under the Health Ministry has thrown up startling statistics, but more importantly, examining the minutiae italicises key issues that have been flagged by experts for years now. Over 70% of the patients in tertiary-care hospitals across 15 States and two Union Territories were prescribed antibiotics; over 50% of antibiotics prescribed have the potential to cause AMR. But the most crucial reveal was that 55% of the patients surveyed were prescribed antibiotics as prophylaxis, or as a preventive; only 45% were prescribed antibiotics to actually treat infections; of this, only 6% were prescribed the drugs after identifying the specific bacteria.
AMR occurs when pathogens evolve, fortifying themselves against drugs, and stop responding to antimicrobial drugs. While it is the nature of pathogens to evolve, this ever-increasing crisis is constantly being exacerbated by unsound medical, and animal husbandry practices. It is precisely the sort of misuse and overuse of antimicrobials, as revealed by the survey, which cause the development of drug-resistant pathogens that in turn pose great risk to life and exacerbate morbidity. The World Health Organization (WHO) estimates that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. AMR invalidates the multiple gains that modern medicine has achieved over years, makes infections harder to treat, but also renders other medical procedures and treatments such as surgery, caesarean sections and cancer chemotherapy, much more risky, WHO warns. Infectious diseases specialists and critical-care experts have for long been waving the red flag over AMR, calling for rational prescription of antibiotics, and curbs on the use of drugs to promote growth in animals and plants. It is also clear that there is an antibiotic research and development pipeline crisis, and urgent measures are required to develop new drug candidates, and more equitable access to them. The role of doctors and the government in regulating use of drugs is crucial in this battle, but more so the latter. Patients too are impatient with the medical process, expecting immediate relief to ailments; but medical science offers no magical remedy. Ultimately, it is the agency with the heft to do both, establish systems that strictly regulate the use of antimicrobials and promote and fund research on newer antibiotics that will draw the line — between life and death.
