Practicing Antibiotic Stewardship

Antibiotics have been one of medicine’s most revolutionary breakthroughs. In the world of modern medicine, antibiotics are nothing short of a miracle. Once lethal infections are now routinely cured, credit goes to the discovery and development of these drugs. They have saved millions of lives, transforming infections that once meant a near-certain death into treatable conditions. However, the very effectiveness of antibiotics is under threat due to antibiotic resistance, a looming crisis that could potentially erase decades of medical progress.

Yet, despite their success, antibiotics are under grave threat. The primary reason is overuse and misuse, which are propelling the world towards a public health crisis of antibiotic resistance. Antibiotic stewardship, or the careful management and responsible use of antibiotics, is not just a clinical imperative but a social one. It is essential that we not only preserve these drugs but also protect the future of healthcare for generations to come.

Misuse

Antibiotic resistance is a phenomenon where bacteria evolve to withstand the effects of antibiotics, making infections more difficult to treat. The primary driver of this resistance is misuse. When antibiotics are used unnecessarily for example, to treat viral infections like the common cold, or without a full course completion, bacteria develop defenses against them. This overuse is not limited to humans; agriculture and animal farming contribute to antibiotic overuse, further exacerbating the problem.

The misuse and overuse of antibiotics - whether prescribed unnecessarily, used without finishing the full course, or deployed in animal agriculture - accelerate this process. The consequences are severe as infections that were once easy to treat now require stronger, more toxic drugs, and in some cases, there are no effective treatments left. According to the World Health Organisation, drug-resistant infections could become a leading cause of death worldwide by 2050, surpassing diseases like cancer.

Antibiotic stewardship is a system of strategies that ensures antibiotics are used only when absolutely necessary and in the correct manner. For healthcare providers, this means prescribing antibiotics judiciously i.e. only when bacterial infections are confirmed or highly likely. Diagnostic advancements, such as rapid bacterial testing, can further support prescribers by distinguishing between bacterial and viral infections, thus preventing unnecessary antibiotic use.

Healthcare professionals play a critical role in antibiotic stewardship. Prescribing practices must be judicious, balancing the need to treat infections with the long-term impact on antibiotic efficacy. It is a call to action for doctors, pharmacists, and nurses to educate patients about the importance of using antibiotics appropriately, following the full course, and resisting the urge to demand antibiotics for non-bacterial illnesses.

In addition, healthcare systems can adopt policies to monitor and manage antibiotic prescriptions, particularly in hospital settings where resistant infections can quickly spread. This could include restrictions on certain antibiotics, implementing alternative treatments, and investing in rapid diagnostic tools to distinguish between bacterial and viral infections. Electronic health records and decision-support systems can also help ensure antibiotics are prescribed only when absolutely necessary.

Antibiotic use in animal agriculture is another area requiring attention. In some regions, antibiotics are added to livestock feed to promote growth and prevent disease in crowded, unsanitary conditions. This practice creates a breeding ground for drug-resistant bacteria, which can transfer to humans through food, water, and the environment. Stronger regulations, promoting practices that prioritise animal health without routine antibiotic use, are necessary to reduce the impact of agriculture on antibiotic resistance.

Awareness 

A major factor contributing to antibiotic misuse is public misunderstanding. Many people still believe that antibiotics are a cure-all, effective for viral infections like colds and flu. Public awareness campaigns are essential to correct these misconceptions and emphasise the critical role of antibiotics stewardship. Schools, workplaces, and media can be channels for educating people on the importance of using antibiotics appropriately. Patients, too, must be encouraged to adhere to prescribed doses and avoid leftover or over-the-counter antibiotics without consulting healthcare providers.

Many people are unaware of how antibiotic resistance develops or of the lasting impact of misuse. If patients understand the risks, they are more likely to comply with medical guidance and avoid pressuring healthcare providers for unnecessary prescriptions.

With existing antibiotics under threat, investing in research for new antibiotics and alternative therapies is essential. Development of novel drugs, bacteriophages, or even repurposing old antibiotics with new mechanisms can provide us with additional options in the battle against resistant infections. However, these are long-term solutions, and the more pressing issue is safeguarding the effectiveness of the antibiotics we currently have.

Antibiotic stewardship is a responsibility that transcends any single institution or industry. It is a collective effort involving healthcare professionals, governments, the agricultural sector, and society as a whole. Each decision we make about antibiotics, from prescribing to consumption, has long-term consequences. By committing to antibiotic stewardship, we have a chance to prevent a post-antibiotic era, where routine infections become life-threatening. This is a battle we must win and one where every responsible action matters.

(Dr. Lohani is the executive director at the Health Concern. lohanis@gmail.com)