The Union government has issued the National Treatment Guidelines for Antimicrobial Use in infectious diseases. With no new drug on the horizon, the government has felt the need to bring out the existing levels of reported resistance of these drugs in the country. It has devised a syndromic approach for empirical therapy of common infections.
To contain further development of antimicrobial resistance, implementing hospital infection control practices, formation of active hospital infection control teams in each hospital working round the clock and monitoring and containing spread of infections are part of these norms. Preventing the acquisition of an infection by vaccination for different microbial infections will also help in reducing the need for prescription of antibiotics.
The government will also enforce an antibiotic stewardship programme to find out the lacunae and improve upon the rational use of antibiotics with appropriate interventions and strategies.
According to Kaushik Desai, general secretary, Indian Pharmaceutical Association, the move is excellent by the government. This also gels with global issue of fighting antimicrobial resistance. These norms explicitly state that antimicrobials should be prescribed only when they are necessary for treatment following a clear diagnosis. The key factor is that these guidelines must be understood by each pharmacist working not just in hospitals but retail pharmacies too. The need of the hour is to help in bringing awareness about antibiotic resistance and its misuse.
The guidelines lists recommended treatments for common infectious diseases that are based on scientific evidence, literature review and are consistent with the already existing international norms. It is formulated with the collective opinion of recognised national experts. Empiric treatment choices for different syndromes, infections of specific body sites, and in certain special settings; antimicrobial choices for multidrug resistant bacteria pathogens, monitoring use of antimicrobials; preventive strategies for healthcare associated infections, case definitions and diagnosis of common infections are clearly provided. The guideline has emphasised that not all patients need antibiotics and non-drug treatment may be suitable.
The content of these treatment guidelines will undergo a process of continuous review and in this regard the government has called for comments or suggestions for improvement. The norms provides only suggestive procedures. The protocols are general and may not apply to a specific patient. Therefore the norms should not replace clinical judgment, factors like hemodynamics of specific patients, availability of antimicrobials and local antibiogram of healthcare setting need to be considered.
Before starting presumptive therapy, medical experts should follow up on standard investigations for all suspected infections for accurate diagnosis and prognosis. The timing of initial therapy should be guided by the patient’s condition and urgency of the situation and can preclude opportunity to establish a microbiological diagnosis, which is critical in the management of these patients.
Merits and limitations of empiric versus definitive antimicrobial therapy should be clear to the doctor prescribing antimicrobials. Since laboratory results for microbiological tests are not available for 24 to 72 hours, initial therapy for infection is often guided by the clinical presentation. Therefore, a common approach is to use broad-spectrum antimicrobial agents as initial empiric therapy with the intent to cover multiple possible pathogens commonly associated with the specific clinical syndrome. However, once laboratory results are available with identification of pathogen along with antimicrobial susceptibility data, every attempt should be made to narrow the antibiotic spectrum. This is critically helpful because it can reduce cost and toxicity besides significantly delay the emergence of antimicrobial resistance.