Failure to ensure absence of bacterial, fungal or viral contamination in healthcare settings cannot be compensated by irrational or irresponsible use of antimicrobials.
Failure to ensure absence of bacterial, fungal or viral contamination (asepsis) in most of the healthcare facilities seems to be the main culprit behind this. Patients are often prescribed unnecessary doses of high-end antibiotics to take care of any hospital acquired infection that they may contract during their stay in the hospital.
"If a woman goes for an abortion or to deliver a baby to a healthcare facility that does not have proper asepsis (absence of bacterial, fungal or viral contamination), then to cover up for that, she is usually administered broad spectrum antibiotics and that too for a variable period of time. Even though most of the obstetric interventions for delivery do not require antibiotics (the recommendation is just one shot of antibiotic), women usually end up consuming high-end antibiotics that are not required, thus fuelling antimicrobial resistance," said Prof Amita Pandey.
Another example she cites is of pelvic inflammatory disease, that is very common in women, for which the first line of drug is doxycycline. "But if a higher end antibiotic is prescribed, then we are fuelling antimicrobial resistance," she says.
Good policy, not-good implementation
The Indian Council of Medical Research (ICMR) has developed evidence based treatment guidelines for rational use of antimicrobials and categorically classified which antibiotics have to be used at which level of care. It also has also made a robust Antimicrobial Stewardship Programme which aims to prevent not only antibiotic resistance but also resistance to other antimicrobials, such as anti-virals, anti-fungals and anti-parasitics.
But unfortunately, these guidelines are rarely followed, except by some tertiary care hospitals. Moreover,"70% - 80% of the women reporting to the hospitals that have a very robust antimicrobial policy in place, including my hospital, are those referred from other health facilities where they have already received high-end antibiotics. So they have to be given even higher level of antibiotics in case sepsis sets in," rues Prof Pandey.
"It is very common to come across antibiotic resistance in most of the women who are referred to our tertiary-care hospital from various levels of healthcare facilities - tier 1 and tier 2 public hospitals and private hospitals. At the slightest doubt of infection in these patients, we have to start with very high-end antibiotics, as they have already been subjected to the low-rung antibiotics for a very long time and hence are resistant to most of them. But for women who are directly registered at our centre for an obstetric intervention, and not referred from elsewhere, we start with the bare minimum recommended single dose of antibiotics. Only when she does not respond to it and there are signs of sepsis do we go to the next higher level," said Prof Pandey.
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