IMA Antibiotic Policy
Dr K K Aggarwal, National President IMA
Preventing Antimicrobial Resistance: Points Every Doctor must know
- Antibiotics are not required in viral infections (acute small intestinal diarrhea, cough, cold with fever, dengue, chikungunya, mild superficial skin infections).
- More than 50% use of antibiotics is unnecessary leading to emergence of antimicrobial resistance (AMR).
- Antibiotic should be administered in proper dose, interval, duration or route of administration.
- Antibiotic regimens should be converted from intravenous to oral administration as soon as is feasible and clinically indicated. Highly bioavailable antibiotics (IV = Oral absorption) are fluoroquinolones, azithromycin, trimethoprim-sulfamethoxazole, metronidazole and fluconazole.
- Restrict antibiotic administration to the minimum duration required for maximum efficacy.
- Use of serum procalcitonin measurements has been demonstrated to provide the clinician with confidence to discontinue therapy in critically ill patients with suspected bacterial infection.
- Procalcitonin is a peptide precursor of calcitonin released by parenchymal cells in response to bacterial toxins, leading to elevated serum levels in patients with bacterial infections; in contrast, procalcitonin is down-regulated in patients with viral infections. Procalcitonin has been studied prospectively to facilitate the decision of whether to use antibacterial agents in patients with pneumonia and when antibiotics can be safely stopped. Do not prescribe antibacterials in patients with a procalcitonin level <0.1 mcg/L; give antibacterials to patients with procalcitonin levels >0.25 mcg/L
- Procalcitonin guidance for antibiotic use is associated with a reduction in antibiotic exposure (from a median of 8 days to 4 days) without an increase in mortality or treatment failure. Procalcitonin facilitate the decision to stop antibiotics since the levels reflect bacterial replication.
- CRP >40 mg/L has a sensitivity and specificity for bacterial pneumonia of 70% and 90% respectively.
- In patients receiving empiric antibiotic therapy, the regimen should be reevaluated on a continuing basis as the clinical status evolves and microbiology results become available (often after 48 to 72 hours). At this point, an "antibiotic time-out" should be performed, in which microbiology results are reviewed and antibiotic therapy is adjusted from empiric to definitive antibiotic therapy. The spectrum of coverage may be narrowed or broadened as appropriate, the dose may be adjusted as needed, and unnecessary components of the regimen should be eliminated.
• Do not use antibiotics in animal husbandry and agriculture as growth promoters.
• Antibiotics are not antipyretic or antitussives.
• Use antibiotics wisely and not widely.
• Think before you ink.
(Contributions from Dr Arun Shah)