The National Medical Commission (NMC) has recommended doctors to treat patients with antibiotics in the presence of diagnostic reports and situations of severity in its recently released National Action Plan on Antimicrobial Resistance (NAP-AMR) Module for Prescribers 2024. In the module, the Commission declared, "The decision to treat with antibiotics should be made by the presence of severity and laboratory report of sputum and culture examination," noting that empirical antibiotic therapy should only be applied to patients who were really sick.
In light of the growing threat of antimicrobial resistance (AMR), which is currently one of the biggest global public health threats facing humanity, NMC had released the Module for medical students, doctors (residents, faculty, medical officers, etc.), and allied health professionals (nurses, pharmacists, technicians, and other allied health professionals), as well as administrators.
According to estimates, drug-resistant illnesses contributed to 4.95 million fatalities worldwide in 2019 and 1.27 million deaths were directly caused by bacterial AMR. AMR jeopardizes many of the advancements in contemporary medicine and poses a challenge to the efficient diagnosis, management, and prevention of infections brought on by resistant microorganisms, increasing the likelihood of chronic illness and even death. Longer periods of infectivity are also caused by treatment failures, and many people may not be able to receive treatment for these infections due to the prohibitively high cost of second-line medications.
Dr. Vijaya Lakshmi Nag, a member of the NMC Ethics Board, and other experts prepared the module, which was released. The NMC discussed the goals of the NMC in this regard, as well as the clinical approach to prescribing antibiotics, microbiological diagnostic stewardship, interpretation of antibiotic resistance—both the principle and the implications—antimicrobial policy, antimicrobial stewardship, infection control, and prescriber toolkits and presentations.
During the discussion about the clinical approach to antimicrobial prescription, the Commission emphasized the significance of precise and comprehensive assessment as well as appropriate communication between the laboratory and the physicians.
Effective communication between the laboratory and the doctors is essential. In order to implement treatment therapies within the intended time range, prescribers need to be informed of favorable culture findings as soon as possible. The antibiograms should be the deciding factor when it comes to initiating antibiotics. In addition to being an affordable method of treating infections, this will also lower AMR, as the NMC said in the module.
In addition, the lesson included a thorough explanation of the variables influencing the choice to prescribe antibiotics.
According to the Module, the following procedures should serve as the foundation for antimicrobial prescriptions:
First, making a clinical diagnosis by precise history taking and a comprehensive clinical examination aids in matching the appropriate test to the appropriate patient. Predicting the most likely organism causing a clinical condition is another benefit of a clinical diagnosis. Antimicrobials must be started before the sample is taken.
Step 2: Only very sick patients should receive empiric antibiotic therapy. Based on institutional/local antibiograms, this decision should be made.
Step 3: Considering the antibiogram, select the right antibiotic based on the clinical evaluation and the most likely infection.
Prescription of antibiotics is influenced by a number of variables, such as national sociocultural and socioeconomic contexts as well as patient and professional attitudes toward antibiotic use. Over-the-counter antibiotic use may also be exacerbated by the lack of suitable diagnostic instruments and the nation's inadequate regulatory framework. In order to meet the challenges of using antibiotics in routine clinical practice, medical personnel need to be suitably equipped.National Medical Commission (NMC)
The updated guidelines further stated that documenting the classic signs of fever, cough, sputum, breathlessness, dyspnea, hemoptysis, and chest discomfort may indicate a communicable respiratory disease such as pneumonia. It was made clear that the existence of severity and the laboratory report of the sputum and culture investigation should be taken into consideration when deciding whether to treat with antibiotics.
"Surgical conditions like choledocholithiasis or cholangitis, as well as medical illnesses like viral or alcoholic hepatitis, leptospirosis, malaria, dengue, etc., can cause jaundice and abdominal pain. To narrow down the differential diagnosis, prescribers should obtain a thorough history of any recent travel, drug addiction, blood transfusions, surgeries, etc.," the statement continued.
A hospital's antimicrobial policy is crucial, according to NMC, which also notes that it "helps to preserve the effectiveness of antimicrobial agents in the treatment and prevention of communicable diseases" and "minimizes the morbidity and mortality due to antimicrobial-resistant infection."
"The policy must define prophylaxis, empirical and definitive therapy and must incorporate specific recommendations for the treatment of different high-risk/special groups such as immunocompromised hosts; hospital-associated infections and community-associated infections," the module stated.
Antimicrobial resistance (AMR): What is it?
The NMC module explained the problem of antimicrobial resistance (AMR) as follows: "AMR is the result of microbes changing over time and developing a resistance to medications, which makes common diseases more difficult to treat and raises the risk of disease spread, serious illness, and death. The effectiveness of antibiotics and antimicrobials, which are essential for operations, chemotherapy, and the treatment of persistent infections, is threatened by this, making it a serious concern. Adding to the complexity is the rise of multi-drug resistance organisms (MDROs), which are "superbugs" that are resistant to a wide range of antimicrobials, making illnesses extremely challenging to treat.
The module described antibiotic-resistant bacteria (AMR) as a "complex problem" and stated that it calls for a coordinated multisectoral strategy that takes into account things like animal and human abuse of antibiotics, good hygiene, and the creation of new medications. It poses a persistent danger to contemporary medicine globally and has a detrimental impact on the course of patient care. The module said that common infectious diseases like pneumonia, TB, and foodborne illnesses are becoming more difficult to cure due to pathogens developing resistance mechanisms.
The AMR Global Action Plan, or (GAP-AMR) :
Recognizing the seriousness of the antimicrobial resistance (AMR) issue, the World Health Assembly (WHA) collaborated with the Food and Agricultural Organization (FAO), the World Organization for Animal Health (WOAH), and other organizations to adopt the Global Action Plan on AMR (GAP-AMR) in 2015.
The National Action Plan on Antimicrobial Resistance (NAP-AMR) Module for Prescribers covers the following topics:
The National Medical Commission's (NMC) goals are:
The module outlined the NMC's goals with regard to antimicrobial resistance, stating that through efficient training and teaching, the organization hopes to raise public knowledge and comprehension of AMR.
The Apex Medical Commission also aims to maximize the application of antimicrobial agents for human health. Enhance the knowledge and abilities of medical trainees, prescribers, and dispensers are the intervention activities listed for accomplishing the goal.
(Input from various sources)
(Rehash/Priyanka Pandey/MSM)