rational use of antimicrobials

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hello netRUMians Antimicrobials are considered as the greatest discovery of the twentieth century. In the pre-antibiotic era, infectious diseases accounted for most of the morbidity and mortality. All this changed with the use of antimicrobial agents. But the miracle seems to be short lived. Irresponsible and erratic use of these life-saving instruments has resulted in development of drug resistance in many organisms and deaths due to hospital-acquired infections is on the rise. On the other hand, not many new antimicrobial molecules have been discovered since the eighties. If the early 1900 saw the birth of antimicrobials in our fight against bacteria to save lives, at the end of 1900 we are seeing the death of these once-very-useful weapons and now have to fight against the resistant bacteria to save these important discoveries of man from extinction! 70-80% of prescriptions for

antimicrobials are probably written unnecessarily Following may be the reasons- 1) Lack of confidence 2) Peer pressure 3) Patient pressure 4) Company pressure The three most common situations for antibiotic abuse- 1) fever 2) diarrhoea 3) Sore throat ( Available at URL: http://rationalmedicine.org/drugs/antibiotics_abuse.htm) WHO advocates 12 key interventions to promote more rational use: Establishment of a multidisciplinary national body to coordinate policies on medicine use Use of clinical guidelines Development and use of national essential medicines list Establishment of drug and therapeutics committees in districts and hospitals

Inclusion of problem-based pharmacotherapy training in undergraduate curricula Continuing in-service medical education as a licensure requirement Supervision, audit and feedback Use of independent information on medicines Public education about medicines Avoidance of perverse financial incentives Use of appropriate and enforced regulation Sufficient government expenditure to ensure availability of medicines and staff. (available at URL: http://www.who.int/medicines/areas/rational_use/en/index.html) There are certain "drug use indicators" for rational use of medicines- Prescribing indicators * Average number of drugs per encounter * Percentage of drugs

prescribed by generic name * Percentage of Encounters with an antibiotic prescribed * Percentage of encounters with an injection prescribed * Percentage of drugs prescribed from essential drug list or formulary ( available at URL: http://www.icm.tn.gov.in/synopsis/DRGINDIC.htm) So the antimicrobials are the "double edge sword" its on us how to use them... regards dr. sarang

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