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NEWS: Philip Wilson New antibiotics are needed as resistance grows, expert says BMJ 2008; 337: a1660 [Full text]

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Do antimicrobial policies serve the purpose?

Shazia Qasim Jamshed, Dr Zaheer-ud-din Babar, Dr Mohamed Izham Mohamed Ibrahim   (14 September 2008)

New antibiotics are needed as resistance grows, experts say

Kyaw Lun Aung Hmu, Stephanie Fulton   (15 September 2008)

Do antimicrobial policies serve the purpose? 14 September 2008
Shazia Qasim Jamshed, PhD Scholar Social Pharmacy, Universiti Sains Malaysia, Dr Zaheer-ud-din Babar, Dr Mohamed Izham Mohamed Ibrahim Send response to journal: Re: Do antimicrobial policies serve the purpose?	In the News “New antibiotics are needed as resistance grows, expert says” Philip Wilson beautifully chalked out the views of experts about the necessity of new entities in the area of anti-infectives as well as highlighting the hurdles and fears of industries to invest in this presumably unprofitable field. As pointed out in last paragraph we have to look the other side of coin too. Irrational prescribing of antibiotics and increased antimicrobial resistance being directly proportional to each other seem to be a global phenomenon. A view of the studies of either 1970’s or 2000’s on antibiotic prescribing patterns clearly reflects results in accordance with each other. Moreover, there are detailed proofs, which thoroughly relate antimicrobial resistance to overuse. Hospital acquired resistance is more common as more antibiotics are used in this setting.In order to cut down on antimicrobial resistance with proper check on prescribing patterns, the induction of policies must be an integral part of hospital infection control program. Although a large body of evidence strongly pointed out fruitful outcomes in this regard, the studies generally encompass single institution or even single entity in an institution. An antibiotic policy is much more than an established code of principles. It must emphasize on imparting and acquiring knowledge with evaluative responses as well as different plans to improve prescribing patterns. Educational strategies should be tailor- made according to the need of the institution. For instance, ICF i.e. Immediate Concurrent Feedback, being a strategy to arrest irrational use of sultamicillin or co-amoxiclav in a Hong Kong hospital decreased the average monthly usage with net monthly savings being HK$26-30,000. [1]. But still this is not a hard and fast rule that Antibiotic policies and National guidelines always work. For a change in prescribing pattern a change in the mindset of every stakeholder will reap the benefit. "There is no pillow so soft as a clear conscience” Reference [1] Seto WH, Ching TY, Kou M, Chiang SC, Lauder IJ, Kumana CR. Hospital antibiotic prescribing successfully modified by 'immediate concurrent feedback'. Br J Clin Pharmacol. 1996 Mar;41(3):229-34 Competing interests: None declared
New antibiotics are needed as resistance grows, experts say 15 September 2008
Kyaw Lun Aung Hmu, assistant physician Mandalay General Hospital, Mandalay, Myanmar, Stephanie Fulton Send response to journal: Re: New antibiotics are needed as resistance grows, experts say	Indeed some bacteria have now acquired resistance to once-effective anti-microbials. That can pose great problems especially in the hospital settings. Resistance means failure of our treatment which in turn can mean death of patients.Antibiotic resistance can be due to multiple causes. They include injudicious use of current effective antibiotics, lack of proper antibiotic policy, lack of adherence to such policy, and ability of the bacteria to develop resistance.Most authors and experts point to the importance of proper antibiotic policy, judicious use of the drugs and education of both doctors and patients. However there is a fact which has long been neglected. That is investment in research and development of newer antibiotics. In the past 20 years or so there have been a lot of efforts in developing vaccines and drugs against viruses. As a result great accomplishments can be witnessed with regard to management of hepatitis viruses B and C and HIV infection. Now it is high time for us to turn to war against bacteria. Greater efforts and investment are required in research and development of newer anti-bacterials. Drug companies should be encouraged to do that function. They should be offered incentives not only in the form of financial profits but also in recognition and reputation, in their doing so. One suggestion I would like to make is to consider combination drug regimens using current antibiotics as in treatment of TB and Malaria. Competing interests: None declared