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Introduction: 

Antibiotic resistance has become an urgent global concern, presenting formidable challenges to healthcare professionals (HCPs) worldwide. According to a source, 50% of antibiotics used globally are prescribed incorrectly and almost 214,000 newborns die each year from drug resistance infections. Shockingly, only 1 new class of antibiotics has been developed in the last 30 years or so.From the widespread misuse of antibiotics to the pressures imposed by patient demands and the scarcity of research, HCPs find themselves entangled in a complex battle that demands immediate attention and collective action. An overwhelming majority of physicians, comprising 97% of respondents, share a common belief that the widespread and inappropriate use of antibiotics stands as a significant contributing factor to the emergence and spread of antimicrobial resistance.This collective awareness among medical professionals underscores the gravity of the issue and highlights the urgent need for responsible antibiotic stewardship. Physicians, being at the forefront of healthcare, have a unique vantage point to witness the consequences of antibiotic resistance firsthand. The increasing prevalence of drug-resistant infections poses formidable challenges in treating once manageable diseases, resulting in prolonged illnesses, higher healthcare costs, and even mortality. As guardians of public health, physicians recognize their critical role in combatting antimicrobial resistance and preserving the efficacy of these life-saving medications for current and future generations.In their day-to-day practices, physicians strive to strike a delicate balance between providing optimal patient care and safeguarding the efficacy of antibiotics. They are acutely aware that inappropriate or excessive prescription of antibiotics can lead to the development of resistant bacteria, rendering these drugs less effective over time. As such, responsible prescription practices and adherence to evidence-based guidelines have become paramount in the fight against antimicrobial resistance.Moreover, physicians actively engage in educating their patients about the risks associated with antibiotic misuse and the importance of adhering to prescribed treatment regimens. Patient awareness is instrumental in fostering a collaborative approach towards combatting resistance, empowering individuals to make informed decisions about their health and treatment options.Beyond the realm of clinical practice, physicians advocate for systemic changes and policies aimed at mitigating antimicrobial resistance on a larger scale. They collaborate with healthcare institutions, policymakers, and regulatory bodies to promote the implementation of strategies such as antimicrobial stewardship programs, infection prevention measures, and surveillance systems to monitor resistance patterns.Furthermore, physicians are vocal proponents of research and development efforts to explore alternative treatment options, such as new antibiotics, novel therapeutic approaches, and vaccines. By supporting and contributing to scientific advancements, they seek to expand the arsenal of tools available in the battle against drug-resistant infections.By understanding the gravity of these challenges, we can explore the multifaceted nature of the issue and highlight the crucial need for collaborative efforts in overcoming antibiotic resistance. Addressing antibiotic resistance requires a multifaceted approach, including appropriate and judicious use of antibiotics, improved infection prevention and control measures, development of new antibiotics, and public education about the responsible use of antibiotics.In this blog post, we will delve into the intricate obstacles that doctors face when combatting antibiotic resistance. 

Antibiotic Misuse and Over prescription: A Troubling Reality

One of the significant challenges HCPs encounter is the widespread misuse and overprescription of antibiotics. Despite being essential for treating bacterial infections, antibiotics are often misused, leading to the development of resistance. Patients may demand antibiotics for viral infections, where they are ineffective, or pressure doctors to prescribe them as a precautionary measure. This practice contributes to the emergence of drug-resistant bacteria, jeopardising the effectiveness of antibiotics for future generations. HCPs face the daunting task of striking a delicate balance between addressing patient concerns, educating them about appropriate antibiotic use, and adhering to evidence-based guidelines.Doctors play a crucial role in antimicrobial stewardship, which involves educating patients about antimicrobial resistance and implementing practices to safeguard antibiotics for future generations. To achieve this, doctors can undertake several impactful actions:Firstly, they should ensure appropriate prescription practices, guaranteeing that antibiotics are prescribed and dispensed accurately. Additionally, doctors should leverage rapid point-of-care diagnostics whenever available to aid clinical decisions, advocating for further advancements in cases of inadequacy.Furthermore, preventive measures like vaccinations should be used to protect patients from infections. Environmental considerations should also be taken into account when making antibiotic procurement decisions. This includes supporting administrative policy changes to procure food raised without routine antimicrobials. In the healthcare setting, doctors can make a significant difference by improving sanitation to prevent healthcare-associated infections. Effective waste management practices must be established to efficiently remove pharmaceuticals and microbes.To ensure patients are well-informed, doctors should advise them about the risks associated with antimicrobial therapy and promote preventive measures when applicable. Educating patients on safe and recommended methods for disposing or returning unused antimicrobial drugs is essential to prevent misuse.Lastly, simple yet critical practices like hand hygiene with soap or alcohol-based rubs play a pivotal role in protecting patients from avoidable infections contracted in healthcare settings and curbing the spread of antimicrobial resistance. By embracing these measures, doctors can lead the charge in preserving the effectiveness of antibiotics and safeguarding public health for generations to come. 

Frustration and Worries of Healthcare Professionals

HCPs experience frustration and worry as they witness the consequences of antibiotic resistance firsthand. These dedicated professionals have undergone extensive training to prescribe antibiotics responsibly, adhering to guidelines that aim to optimize patient care while minimizing the development of resistance. A study reported that participants expressed the belief that inappropriate outpatient antibiotic prescribing was mainly driven by clinicians other than themselves, particularly those working in urgent care offices and retail clinics. This perception led to the feeling that resisting patient demands for antibiotics was futile since patients could easily seek another clinician who would fulfil their request.Another prevalent theme that emerged during the focus groups was the pressure from patients who expected antibiotics even when there was no medical indication for them. This issue was repeatedly brought up and discussed throughout the sessions. However, some physicians, primarily paediatricians, mentioned that they were more inclined to push back against prescribing antibiotics if they had a well-established, long-term relationship with the patient. However, they often find themselves grappling with the rising prevalence of resistant bacterial strains, making it increasingly challenging to treat infections effectively. The spectre of untreatable infections and limited treatment options weighs heavily on their minds, prompting a deep sense of concern for patient well-being and the future of healthcare. 

Limited Research and Knowledge Gap

In a survey conducted: out of 200 physicians, 159 completed the survey, resulting in a response rate of 79.5%. The survey revealed that 30.1% (47 out of 156) of physicians perceived antibiotic resistance as a significant global problem. Additionally, 18.5% (29 out of 157) perceived it as a major issue at the national level, while only 8.9% (14 out of 157) considered it a very important problem in their hospital.The survey also found that the most widely recognized antibiotic-resistant bacteria of public health concern was Methicillin-resistant Staphylococcus aureus. Following this, in terms of awareness, were extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant enterococci (VRE).A significant hurdle that HCPs face in the battle against antibiotic resistance is the limited research and knowledge gaps surrounding this complex issue. While significant strides have been made in understanding antibiotic resistance, there is still much to uncover. HCPs require up-to-date and comprehensive information to make informed decisions in prescribing antibiotics, staying abreast of emerging resistance patterns, and implementing effective infection control measures. However, the pace of research in this field can be slow, hindering the availability of robust evidence and innovative treatment strategies. 

Collaboration and Policy Implementation

Addressing the challenges of antibiotic resistance requires collaboration and comprehensive policy implementation. HCPs rely on policymakers, public health organizations, and pharmaceutical companies to create and enforce regulations that promote responsible antibiotic use, restrict over-the-counter availability, and invest in research and development of new antibiotics. Furthermore, multidisciplinary cooperation between healthcare professionals, microbiologists, epidemiologists, and researchers is vital to devise effective strategies to combat resistance, improve infection prevention and control practices, and enhance public awareness about the responsible use of antibiotics. 

Is it different across different countries?

Yes, the challenges and dynamics surrounding antibiotic resistance can vary across different countries. While antibiotic resistance is a global issue, its impact and specific challenges can differ based on various factors, including healthcare systems, cultural practices, regulatory frameworks, and socioeconomic conditions. Here are a few ways in which antibiotic resistance may vary across different countries:

  • Antibiotic Usage Patterns: The patterns of antibiotic use can differ significantly from one country to another. Some countries may have higher rates of antibiotic prescribing, leading to greater selection pressure for resistant bacteria. Factors such as over-the-counter availability of antibiotics, cultural beliefs, and patient expectations can influence prescribing practices and contribute to varying levels of resistance.
  • Healthcare Infrastructure: The quality and accessibility of healthcare infrastructure can vary among countries. In some regions, limited access to healthcare facilities or diagnostic tools may result in overreliance on antibiotics as a precautionary measure or inadequate monitoring of antibiotic use, potentially contributing to resistance.

Dr Sudeshna Adak, a competitor in the Longitude Prize, revealed that her most profound motivation came from a personal experience involving her one-year-old daughter’s urinary tract infection (UTI). For three agonizing days, they were left uncertain about the appropriate treatment, until their pediatrician made a wise decision to wait for the culture report before prescribing any antibiotics. This trying period taught Dr. Adak the true meaning of waiting for the right medicine for a loved one. It was this poignant experience that ignited her determination to seek out a solution that could work within just 30 minutes, providing physicians with essential information to guide antibiotic prescriptions effectively, if needed. Driven by this profound encounter, she and her team at Omix Labs embarked on their journey, aiming to develop a revolutionary tool that would significantly improve the accuracy and speed of antibiotic treatment decisions, benefiting countless patients and their families in similar situations.

  • Regulatory Policies: The regulatory frameworks governing antibiotic use and prescription can differ across countries. Some countries may have stricter regulations in place to control antibiotic availability and enforce appropriate use, while others may have more lenient or less well-enforced policies. These variations can impact the level of resistance and the effectiveness of efforts to combat it.
  • Socioeconomic Factors: Socioeconomic factors, including poverty, education levels, and access to clean water and sanitation, can influence the prevalence and transmission of antibiotic-resistant infections. In resource-limited settings, challenges such as inadequate infection control practices or limited access to effective antibiotics can exacerbate the problem.
  • International Collaboration and Support: Collaboration and support from international organizations and global initiatives play a crucial role in addressing antibiotic resistance. Countries with stronger collaborations and access to resources, funding, and expertise may be better equipped to implement effective strategies for surveillance, prevention, and control of resistance.

It is important for each country to assess its unique challenges and develop tailored strategies to tackle antibiotic resistance based on its specific context. International collaboration and sharing of best practices can also help countries learn from one another and strengthen their collective efforts against this global threat. 

Conclusion:

Antibiotic resistance presents a pressing global concern that demands urgent attention and collaborative action. Healthcare professionals, particularly physicians, play a critical role in combatting this crisis by promoting responsible antibiotic stewardship, educating patients about appropriate use, and advocating for systemic changes and research efforts.The challenges faced by healthcare professionals in addressing antibiotic resistance are multifaceted. Widespread antibiotic misuse and overprescription, patient demands for unnecessary antibiotics, and limited research and knowledge gaps are among the hurdles they encounter. These challenges can lead to frustration and worries among healthcare professionals as they witness the consequences of resistance in their day-to-day practices.Addressing antibiotic resistance requires a comprehensive approach that includes appropriate antibiotic use, improved infection prevention and control measures, development of new antibiotics, and public education. Collaboration between healthcare professionals, policymakers, researchers, and the public is essential in devising effective strategies to combat resistance and safeguard the effectiveness of antibiotics for future generations.It is important to recognize that the dynamics of antibiotic resistance can vary across different countries due to factors such as antibiotic usage patterns, healthcare infrastructure, regulatory policies, socioeconomic conditions, and international collaboration. Each country must assess its unique challenges and implement tailored strategies to tackle antibiotic resistance effectively.By understanding the gravity of these challenges and embracing a collaborative approach, we can work together to overcome antibiotic resistance and ensure a healthier and more sustainable future for healthcare worldwide. 

Resources: 

  1. https://www.stopamr.eu/faq/human-health-professionals/how-doctors-can-help-reduce-antimicrobial-resistance/#:~:text=Doctors%20have%20a%20leading%20role,antibiotics%20for%20the%20future%20generations.
  2. https://pubmed.ncbi.nlm.nih.gov/12390064/#:~:text=Antibiotic%20resistance%20was%20perceived%20as,were%20important%20causes%20of%20resistance.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819203/
  4. https://www.ama-assn.org/delivering-care/public-health/physicians-antibiotic-resistance-problem-not-my-office
  5. https://www.doctorswithoutborders.org/what-we-do/medical-issues/antibiotic-resistance
  6. https://amr.longitudeprize.org/blog/why-are-doctors-worried-about-antibiotic-resistance-in-india/