Antibiotics are among the most frequently used chemicals in both the inpatient and outpatient setting.

Antibiotic resistance has been called one of the world's most pressing public health problems. It can cause significant danger and sufferings for people who have common infections that once were easily treatable with antibiotics. When antibiotics fail to work, the consequences are longer-lasting illnesses; more doctor visits or extended hospital stays; and the need for more expensive and toxic medications. Some resistant infections can cause death. While these antimicrobial agents are generally well tolerated, these drugs are not without their associated side effects, both dose-dependent and idiosyncratic and hypersensitivity reactions in nature. The use of antimicrobial agents inevitably leads to the emergence of resistant micro-organisms. It also destroys the normal flora of the body and renders patients far more susceptible to colonisation with microorganisms introduced from elsewhere in the hospital through the process of cross infection. Many patients who eventually colonised and infected with MRSA and ESBL strains. While diarrhoea is a commonly associated with adverse effect of many antibiotics, toxic effects on the central nervous system are perhaps much less recognized, there is an emerging awareness on irrational use of Antibiotics both in humans and vetnary practices. Indias like many developing countries it is lucrative business to sell the antibiotics; many Doctors follow the advertisements of the pharmaceutical industry and prescribe the antibiotics without even knowing the dynamics of the drugs they prescribe. In the recent past India branded with NDM generator brining ripples in the political circles and the profession. Antibiotic resistance occurs when antibiotics no longer work against disease-causing bacteria. These infections are difficult to treat and can mean longer lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death. The phenomenon is seen in many ICU patients who succumb to the Drug resistant bacterial and fungal infections. If antibiotics are used too often for things they can't treat like colds, flu or other viral infections not only are they of no benefit, they become less effective against the bacteria they're intended to treat. It is not Doctors alone to blame patients too are contributing by not taking antibiotics exactly as prescribed also leads to problems. For example, if you take an antibiotic for only a few days instead of the full course the antibiotic may kill out some, but not all, of the bacteria. The surviving bacteria become more resistant and can be spread to other people. When bacteria become resistant to first line treatments, the risk of complications and death is increased. Better practices by clinicians and Microbiologists can save much needed quality of life *ANTIMICROBIAL PRESCRIBING: GOOD PRACTICES 1. Send for the appropriate investigations in all these infections as recommended. These are the minimum required for diagnosis, prognosis and follow up of these infections. 2. All antibiotic initiations would be done after sending appropriate cultures 3. Change in antibiotic would be done after sending fresh cultures

4. Follow the Hospital policy when choosing antimicrobial therapy whenever possible. If alternatives as chosen, document the reason in the case records. 5. Check for factors which will affect drug choice & dose, eg, renal function, interactions, and allergy. 6. Check that the appropriate dose is prescribed. If uncertain, contact Infectious disease physician, Pharmacy, or check in the formulary. 7. The need for antimicrobial therapy should be reviewed on a daily basis. For most infections 5 7 days of antimicrobial therapy is sufficient (simple UTIs can be adequately treated with 3 days of antibiotic). 8. All IV antibiotics may only be given for 48 72 hours without review and consideration of oral alternatives. New microbiological or other information (eg fever defervescence for at least 24h, marked clinical improvement; low CRP) should at this stage often permit a Switch to oral antibiotic(s), or switch to an IV narrow spectrum alternative or cessation of Antibiotics (no infection present). 9. Once culture reports are available, the physician shall step down to the narrowest spectrum, most efficacious and most cost effective option. If there is no step down availed, the reason shall be documented and is subjected to clinical audit. 10. Empiric Therapy - Where delay in initiating therapy to await microbiological results would be life threatening or risk serious morbidity, antimicrobial therapy based on a clinically defined infection is justified. Where empiric therapy is used the accuracy of diagnosis should be reviewed regularly and treatment altered/stopped when microbiological results become available 11. Microbiological samples must always be sent prior to initiating antimicrobial therapy. Rapid tests, such as Gram smears, can help determine therapeutic choices when empiric therapy is required. 12. Prescribing antibiotics just in case an infection is present is rarely justified. Where patients are in hospital close observation is usually a better option*(GUIDELINES FOR ANTIMICROBIAL THERAPY CMC Ludhiana) Antibiotic resistance is not just in India it is a global health problem. Nearly all significant bacterial infections in the world are becoming resistant to commonly used antibiotics. When you misuse antibiotics, you help create resistant microorganisms that can cause new and hard-to-treat infections. That's why the decisions you make about using antibiotics unlike almost any other medicine you take have far-reaching consequences. Be responsible in how you use antibiotics to protect your health and that of your family, neighbours and community. Need for Antibiotic policy All the Doctors and Microbiologists should accept the importance of creating Antibiotic policy as it is not few patients but we are putting society as risk Sick individuals aren't the only people who can suffer the consequences. Families and entire communities feel the impact when disease-causing microbes become resistant to antibiotics. These antibiotic-resistant bacteria can quickly spread to family members, school mates and co-workers - threatening the

community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.( Source: Centres for Disease Control (www.cdc.gov) The best course of action is education. People need to learn not only about what antibiotics can and cant do, but about alternative treatments as well. If we keep abusing antibiotics, eventually well be out of solutions for all bacterial infections, The best way to live and let live, think before you take antibiotic and physicians should think before prescribing an antibiotic just read a well written documents on antibiotics as education continues boon for all Ills, do not be guided by pharmaceutical industry and sales people. Dr.T.V.Rao MD Professor of Microbiology Freelance writer