Refrain from prescribing antibiotics before conducting diagnostic tests – the National Medical Commission (NMC) has said in the latest guidelines issued for faculties and senior residents in medical colleges across India.
To combat the rise in antibiotic resistance, the NMC — the regulator for medical education and doctors in India — has emphasised prescribing appropriate antibiotics or antimicrobials based on clinical evaluation and the most likely pathogens.
On June 14, the NMC sent its 156-page guidelines, ‘National Action Plan on Antimicrobial Resistance (NAP-AMR) Module for Prescribers’, to medical institutions.
According to the guidelines, the prescription of antimicrobials should be based on certain steps which begin by making a clinical diagnosis based on “accurate history taking and thorough clinical examination”, which helps in selecting the “right test for the right patient”.
It suggests that a clinical diagnosis also helps in predicting the “most likely organism” causing a clinical syndrome. “The sample must be collected before the start of antimicrobials,” the guidelines suggest.
The guidelines restrict experience-based antibiotic therapy to “only seriously ill patients” when the doctor is not aware of the exact reason behind the illness.
The move was triggered after the Directorate General of Health Services (DGHS) – a wing under the Ministry of Health and Family Welfare – in January instructed doctors nationwide to clearly state the indication, or reason, whenever they prescribe an antibiotic to a patient. According to the World Health Organization (WHO), India has one of the highest infectious disease burdens globally.
WHY HAS NMC DESIGNED THESE GUIDELINES?
According to the NMC guidelines, the use of antimicrobials has grown manifold in recent years. The central government has been trying to curb the overuse of antibiotics and anti-microbials in India for the past many years.
“Easy access to antimicrobials and the haste to start them in any suspected infective aetiology is primarily responsible of their misuse, and in turn lead to increased anti-microbial resistance (AMR),” the document noted.
AMR occurs when microorganisms change over time and become resistant to drugs, making common infections harder, increasing the risk of disease spread, severe illness and death.
“This is a significant threat as it undermines the effectiveness of antibiotics and antimicrobials, which are crucial for surgeries, chemotherapy and managing chronic infections,” the guidelines said, adding that the emergence of multi-drug resistant organisms further complicates the issue, as these “superbugs” are resistant to many different antimicrobials, making infections very difficult to treat.
In short, these pathogens are developing resistance mechanisms, complicating the treatment of common infectious diseases such as pneumonia, tuberculosis, and foodborne illnesses.
WHAT SHOULD BE CONSIDERED AFTER PRESCRIBING ANTIBIOTICS?
Infectious disorders can be caused by bacteria, viruses, fungi or parasites. The guidelines suggest that identification of the clinical problem and making a differential diagnosis will help in deciding whether to start any antimicrobial or not.
The clinician should always take a detailed history of presenting infection, and a history of any surgical, medical disorders, or co-morbidities like diabetes as these may put an individual at risk of getting infections. “History of previous hospital admission, recurrent infections in the past, surgical intervention or any organ transplant should be taken. Previous use of antibiotics in such situations may predispose for AMR in current illness.”
Guidelines suggest that an “antimicrobial must be given at the optimal dose, frequency and duration, based on individual patient characteristics such as age, weight, renal function, likely causative organism, site of infection” and many other factors.
Also, if the doctor is starting antibiotics or antimicrobial therapy based on experience, but not diagnostic results, such empiric antimicrobial therapy should be reviewed on a daily basis by the clinician responsible for the patient’s care.
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