Rational Use of Drugs in Hospitals

The bacterial drug resistance has followed the advent of antimicrobial therapeutics like a faithful shadow. Today the world authorities are though basking in the glory of about the discovery of entirely new group of antimicrobials, the drug resistance is increasing at a galloping pace. Before seventies, genetic materials were the only ways for the bacteria to become resistant but in the last couple of decades the infectious multiple drug resistance through bacterial plasmids has emerged as a growing menace. In the hospital practice Gram negative bacteria have assumed the new heights of resistance not only to a few newer antibiotics at a time, but to almost all the older generation of antibiotics simultaneously.  Unless the medical fraternity gets united to stop the indiscriminate and irrational use of drugs and implement the proper strategies, a day may not be far away to throw us back to the pre antibiotic era.

Guidelines:

1. In order to stop the indiscriminate use of drugs it is essential to select and continue antibiotics based on the drug sensitivity reports..

2. Prophylactic use of antibiotics before surgery needs to be discouraged.

3. Antibiotics can be avoided in noninvasive diarrheas.

4. Simple penicillin group of drugs are still the best drugs to treat infections such as sore throats caused by Beta-hemolytic streptococci.

5. The patients with multiple drug resistant bacterial infections need a special care in the units to avoid cross infections from them.

6. Antibiotic usage policies need to be formed for every hospital but can work only with the cooperation with the clinicians.

7. The recent laboratory data on the susceptibility patterns can be used to start the antibiotics empirically before the drug sensitivity reports reach the clinicians.

8. The third generation and more recent antibiotics may be used for the patients, only if routine drugs are found resistant as per the laboratory report.

9. As a general approach in emergency, a combination of aminoglycoside and cephalosporin may be tried till the availability of the culture sensitivity results.

10. Some of the drugs could be kept as only reserve drugs to avoid the emergence of drug resistance in a given hospital. With the reluctance of the use of the furadantin for UTI, in the recent years, in hospitals, the incidence of resistance for the same has gone down dramatically.

Dr. (Brig) Anil Pandit

Professor- MBA (HHM)