Antibiotics are used to treat numerous infections, but due to their constant use, many bacteria are developing resistance. As a result, treatment options, even for minor infections, are narrowing.
The Indian Council of Medical Research (ICMR) is working on India's first-ever guidelines for the empirical use of antibiotics for upper respiratory tract infections and community-acquired pneumonia, as antibiotics have been heavily used for these conditions lately.
According to an epidemiology study, around 297,000 deaths in the country were directly linked to antimicrobial resistance, with indirectly linked deaths around 1,042,500.
Empirical therapy refers to the administration of antibiotics when the pathogen (bacteria, virus, or fungi) is not yet identified. This can cause resistance among pathogens, or the pathogen may already be resistant, leading to antibiotics being ineffective. This increases the risk of infections spreading and causing severe complications.
The aim of this initiative is to create evidence-based guidelines, ensuring empirical therapy is only used for specific conditions where pathogens are already identified. This is crucial, as the country witnessed massive abuse of azithromycin during the COVID-19 pandemic, where it was used in large populations, even for patients who did not need it.
The document will provide detailed guidelines for antibiotic use in upper respiratory tract infections, fevers of unknown origin, and community-acquired pneumonia. These guidelines are based on systematic reviews and meta-analyses of previous research and literature.
Key questions raised during the review of the guidelines include when to start empirical antibiotics, what class of antibiotics to use, and when to stop or switch them. According to the WHO’s AWaRe classification of antibiotics developed in 2017, there are three classes:
Watch: Antibiotics like azithromycin, which have a higher potential for resistance and are commonly used. These medications should be carefully monitored and prescribed.
Access: Narrow-spectrum antibiotics with fewer side effects, lower potential for resistance, and lower cost fall under this category. These are recommended for empirical therapy for most infections.
Reserve: These antibiotics should only be used as a last resort in severe infections caused by multi-drug-resistant pathogens.
The guidelines aim to develop an algorithm to assist clinicians in prescribing antibiotics and to prioritize drugs in the Access category for most cases.
Through the initiative, our aim is to create evidence-based guidelines on empirical use of antibiotics for some common conditions for which the exact cause or pathogen has not been diagnosed,
Senior ICMR scientist
According to a study, up to 95% of upper respiratory tract infections presenting common symptoms don’t need antibiotics, but many physicians still prescribe them for every chest infection. Antibiotics should only be used if the pathogen is known.
These guidelines will help doctors in outpatient departments select the right diagnostic tests and prescribe appropriate antibiotics. Many health agencies in developed countries, such as the USA, already have algorithms to guide primary caregivers in treating patients accordingly.
Doctors can categorize the severity of symptoms into categories A, B1, B2, and C to determine if testing is required.
In areas where dengue is prevalent, if a patient reports fever, joint pain, myalgia, headache, and excessive fatigue, the doctor should suspect dengue fever. In such cases, a diagnosis should be sought, and supportive care should be provided, but antibiotics are not necessary.
(Input from various sources)
(Rehash/Yash Kamble/MSM)
