India is the largest producer and consumer of antibiotics. The ultimate threat of antibiotics resistance is already rearing its ugly head with Indians reporting high levels of resistance to fluoroquinolones, cephalosporins and carbapernems.
WHO states this resistance to antibiotics after its over use and abuse leads to 1.27 million deaths per year across the globe. So what’s the general rule when it concerns antibiotics? Dr Neha Gupta, Consultant- Infectious Diseases, Fortis Memorial Research Institute, Gurugram explains, “Our body gets infected due to several reasons.
Drugs which act against bacterial infection are called antibiotics. These either kill or suppress the activity of bacteria and are also known as ‘magic bullets’.”
The general rule when it comes to antibiotics use is ‘to
not take them without a proper diagnosis’. It should be taken only under a doctor’s supervision. Dr Neha adds, “Use of antibiotics depends on the cause of the infection and the bacteria that is responsible for it.
For example, if a person has got skin boil they have to be given antibiotics immediately in order to check the spread of the infection. The same is the case with a brain infection or an infection of the urinary tract where we have to administer the antibiotic immediately. Currently we are seeing lots of coughs and colds and it is very difficult to differentiate whether it is a viral infection or a bacterial infection. For example if a person comes with fever, cough and cold and has runny nose and body pain it indicates viral infection. In viral infection the disease peaks during the first 2 days and then starts receding.
Now, here is an important thing which needs to be known in view of the rising cases of flu and COVID. Fever is a common sign in all respiratory tract related diseases. However, fever does not mean you need to have antibiotics. In case of an upper respiratory tract infection, we need antibiotics if the fever is increasing even on day three, there is a productive cough with sputum and severe throat pain. So we need to understand that upper respiratory tract infections can either be caused by bacteria or by a virus. Pathological tests can confirm this correctly.”
Talking about the importance of correct doses, Dr Neha says, “Antibiotics are magic bullets. If we need them, we should take them in the correct doses. People should not consume it mindlessly. It can lead to drug fever, which includes liver dysfunction, rashes, slurring of speech, and can lead to neurotoxicity. It can also lead to diarrhea, so it is important to make a diagnosis first.
Currently many people are having an upper respiratory tract infection which is accompanied by runny nose, severe body ache, sore throat, and dry cough; these indicate towards a viral infection. If there is no cough but if the fever is as high as 102F, it indicates a bacterial infection.
Antibiotics are also required for atypical bacterial infections. They are prescribed in cases where there is a viral infection and a secondary bacterial infection. For example, if a patient develops fever, runny nose, cough and there is an increase in fever and cough. Individual diagnosis is required to prescribe antibiotics.”
The damaging effect of not taking antibiotics at the right time depends on the site of the infection and the bacteria involved in it. For example, if it is a brain infection due to Streptococcus pneumoniae or a lung infection and if antibiotics are not started properly the bacteria can spread to other organs through blood and affect the functioning. Similarly in case of UTI, if left untreated it can affect the kidney.
Dos and don’ts of antibioticsElaborating on the correct use of antibiotics, Dr Neha explains, “One should be careful about food when they are on antibiotics.
Avoid spicy food as it can cause gastrointestinal problems. For example, fluoroquinolone should not be taken with milk and milk products. Azithromycin should be taken in empty stomach as it helps in better absorption of the medicine. Certain antibiotics like penicillin, amoxicillin have to be taken after food.
We also need to take care of other medications while administering antibiotics. For example, Linezolid should not be given to those on antidepressants as these medications can interact.”
The golden rule is to take antibiotics in the right dose and for the right duration. “Many people discontinue the course of the medicine. Sub-optimal doses of antibiotics lead to antibiotic resistance. This is one of the global threats right now and will be posing a greater risk to people even more than the threat by life threatening diseases like cancer.
Over the counter drugs should not be encouraged. In Kerala, giving medicines without a prescription might lead to cancellation of the license of the pharmacies. This step has been taken by the state government in view of the severe side effects due to overuse of antibiotics.
Many diseases for which antibiotics are blindly used currently do not actually need them.”
