“What are the five commonly prescribed Antibiotics by you?"
I asked. A very unpleasant question this was for one of our residents seated in a room of about thirty odd doctors during today's very pleasant Bangalore afternoon.
“Augmentin…
Piptaz….
Clindamycin…
Metrogyl…
….mumble…
Dalacin”
He completed after a lot of contemplation. For those commoners who lack the knowledge of antibiotics, the third and the fifth one are the same, the former being the generic name and the latter being its brand name. While he was happy that he got his five, I thought it would never hurt to ask more and went ahead with my rapid five.
Me: “So….what do you give it for?”
He: ‘Blank’
Me: “How many patients do you give it to on an average?”
He: ‘Blank’
Me: “And how many of them recover”?
He: ‘Blank’
Me: “Do you look at the antibiotic policy of the hospital before prescribing?”
He: ‘Blank’
Me: “Do we have an antibiotic policy in the hospital?”
He: ‘Blank’
I could have gone ahead with my minor dissection on his prescription practice and rationale but the general reaction in the room with department heads, senior consultants, residents and interns was a sight to behold. Working with microbes and antibiotics day in and day out I am of the opinion that the most resistant of all are us Doctors, nobody or nothing else. We are way ahead of all the Multi-Drug, Pan-Drug and Extremely Drug Resistant Microbes that we fret about and deal with in our hospitals.
In the periodical class on Infection Prevention and Control that we conduct for consultants and residents wherein we brief about NABH standards, Standard Precautions, Personal Protective Equipment, Hand Hygiene, Bio-hazard Spill Management, Biomedical Waste Management, Health Care Associated Infections, Surveillance Charts, Antibiotic Policy and Post exposure Prophylaxis the most I could do as a Medical Microbiologist and an Infection Control Officer was to share my little knowledge I have about these issues.
Some days there are few consultants with a ‘rock-solid-will-never-change-my-unit-my-antibiotic-my decision-my responsibility-my patient-I-know-better’ attitude and then some days there are only residents with ‘i-will-only-follow-what-my-head-says’ [read: not the head above his shoulder but the unit head] attitude. Some days there are five in the room, some days about ten and some days there are none. And on all days the laboratory doctors are considered ‘para’-medical and not medical because they see samples, not the patients. The samples are from their own patients is something long forgotten.
Despite all this our quest for training and data collection continues. “To measure is to know, if you cannot measure it, you cannot improve it” so said the great Scots-Irish mathematical physicist and engineer Lord Kelvin. It has not been an easy ride and it will never be, likewise for all doctors dealing with Infection Control especially in small health care settings where constraints are not just with resources but also with the lack of awareness and drive amongst our own peers, it has always been so in most of our Indian hospitals with regards to other situations.
Microbes with novel beta-lactamase enzymes have reached the United Kingdom from our capital and are christened with the city’s name too! New Delhi Metallo Beta-Lactamase! If it sounds very cool and you are a health care personnel you should be more than sorry. At the grass root level we still are far away from deciding on whether to check or not on what happens to the antibiotics that we scribble on our prescription pads. Only the kinds of Nipah Virus can wake us up.
Guidelines and policies are slowly falling into place at all levels but there are hundred other institution and speciality specific issues of Antibiotic Resistance and in the way we approach them, we are facing a silent epidemic and we have a long way to go!
Right Choice, Right Route, Right Dose, Right Frequency & Right Duration-the 5 Rs of Antibiotic Prescription apart, a 6th R would definitely do a lot of good to our patients and also all of us who belong to the medical fraternity- RIGHT ATTITUDE.
A kind request to all my fellow doctors- Know The Antibiotic You Prescribe! If not, we are here at the lab to help.🙂
As you all know we are facing a huge problem of Antibiotic Resistance across the world and India is considered as one of the epicentre of what we call as Superbugs, they are even named after our towns and cities like the famous NDM-New Delhi Metallobetalactamase!🤔
Healthcare associated infections are a huge problem due to antibiotic resistant microbes which increase our hospital stay, they also are a huge expenditure and carry a high risk for mortality.😢
Public perception of the issue is very important in this regard which my doctor fraternity seldom considers for discussion. Since we have to begin somewhere I am carrying out a small survey titled ANTIBIOTIC AWARENESS SURVEY with a few questions to be answered.
If this healthcare issue is of concern to you please participate and help us doctors analyze where we all stand. Thank you, your participation and feedback is highly valuable.🙂
Here is the link :
-R.
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