KEY FACTS ABOUT ANTIBIOTICS
• Antibiotics otherwise termed antibacterials are drugs that can either kill (bactericidal) or slow down bacterial growth and multiplication (bacteriostatic).

• The first antibiotic to be discovered was penicillin by Alexander Fleming in 1928 and the first antibiotic use reported in history was in 1936

• Today several classes of antibiotics are available such as beta lactam antibiotics (penicillins and cephalosporins), macrolides (erythromycin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamycin and amikacin) and sulfonamides (cotrimoxazole). The different classes work in different ways to destroy or retard the growth of bacteria.

• They do this by either destroying the cell wall of bacteria which is critical to its survival or by affecting bacterial cell reproduction or interfering with synthesis of key bacterial proteins necessary for its cellular activities

• Antibiotics are widely used to treat infections such as respiratory, urinary and bowel infections and can be life saving. In fact before the advent of antibiotics, a majority of (over 30%) deaths were due to bacterial infections

• At times antibiotics are given as a preventive measure (prophylactic) when an invasive procedure is to be done for example an operation or a dental procedure or in persons prone to recurrent infections due to a weak immunity

• They are available in the form of tablets, capsules, liquids. Topical antibiotics are also available as gels, creams or drops to treat skin or eye infections respectively. In severe life threatening infections, antibiotics are administered as intravenous (IV) infusions to reach the blood directly.

• Antibiotics are not effective in viral infections such as common cold or fungal infections. Misuse or incorrect prescription of antibiotics can lead to antibiotic resistance where the bacteria become resistant to the drug and become capable of causing serious infections.

ANTIBIOTIC RESISTANCE AND EMERGENCE OF SUPERBUGS
As stated earlier, rampant use of antibiotics and underdosing has led to emergence of bacterial strains resistant to specific antibiotics. Superbug is a term that refers to bacteria that have developed resistance to several antibiotics. Patients infected with superbugs develop serious infections with very few or no options left to treat them. According to the CDC, over 2 million persons develop superbug infections annually across the world

EVOLUTION OF THE SUPERBUG
• Superbugs did not emerge overnight. Bacteria are highly capable of evolving in order to ensure their survival against the onslaught of antibiotics. In fact within 10 years of introducing penicillin, resistant strains emerged in hospitals. Once a bacterium gets the ability to evade an antibiotic, it is able to pass on this property to another bacterium nearby as well.

• The most commonly mentioned superbug is methicillin resistant staphylococcus aureus or MRSA.

This bacterium is resistant to methicillin as well as several other antibiotics. MRSA infections usually involve the skin and seen in persons admitted to hospitals especially those with a weak immunity

• Other serious antibiotic resistant infections include Clostridium difficile infections, vancomycin resistant enterococcus (VRSE) and carbapenem resistant Enterobacteriaceae (CRE)

• Antibiotic resistance can be prevented/ reduced by the following steps

• Take the appropriate antibiotic
• Take the complete course of antibiotics even if you feel better earlier
• Avoid taking antibiotics for viral infections such as common cold, or flu unless indicated
• Doctors should avoid over prescribing antibiotics. A recent study has reported that at least 47 million prescriptions of which 11 million antibiotic prescriptions for kids are avoidable every year

PRESCRIBING THE RIGHT ANTIBIOTIC
• Prescribing the right antibiotic is important both in terms of curing the patient of the infection as well as preventing bacterial resistance to antibiotics

• Bacteria are broadly classified into Gram positive and Gram negative bacteria based on their staining characteristics. Generally speaking, Gram positive cause skin and respiratory tract infections while Gram negative bacteria are associated with bowel and urinary infections.

• The type of bacteria/organism causing the infection must be first determined by the treating doctor by taking a detailed patient history and thorough physical examination

• Most Gram positive bacterial infections respond to penicillins, erythromycin and cloxacillin. Gram negative infections are treated with cephalosporins, quinolones, and aminoglycosides. Certain classes of antibiotics such as carbapenems and the latest generation cephalosporins are effective against both Gram negative as well as Gram positive bacteria.

• When in doubt a broad spectrum antibiotic which is effective against a wide range of organisms may be prescribed. Examples include ampicillin, amoxicillin/ clavulanic acid (Augmentin). Trimethoprim/sulfamethoxazole (Bactrim) or Tetracycline or Ticarcillin.

• Decide whether antibiotic therapy is warranted and if yes, choose the drug that is proven to be most effective and safe for the infection as per clinical studies

• The dose of the drug should be in keeping with the patient’s age, liver and renal function and potential side effects

• Among the safe and effective options, prescribe the least expensive drug as it may ensure patient better compliance

• When antibiotics are not prescribed, the reasons have to be clearly explained to the patient and medications for symptomatic relief should be offered

PROS OF ANTIBIOTICS
• Antibiotics are highly effective and may be lifesaving in several infections such as pneumonia, bowel infections and cellulitis
• They are inexpensive and easily available
• Easy to administer either orally or topically as well as by injections in more severe infections
• Most antibiotics are safe with tolerable side effects
• Broad spectrum antibiotics can be started when the cause of infection is in doubt so that treatment is not delayed while lab results are awaited
• Antibiotics are useful to prevent infection before operative procedures and in patients with impaired immunity such as those receiving cancer chemotherapy

CONS OF ANTIBIOTICS
• Development of antibiotic resistance due to misuse
• Certain antibiotics can cause allergic reactions including life threatening anaphylaxis eg penicillin
• Prolonged antibiotic use may cause alteration of normal gut flora (good bacteria) leading to chronic diarrhea
• Interaction with other drugs and alcohol leading to undesirable effects